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Histologic Patterns in Patients Undergoing Permanent Gastric Electrical Stimulation for Gastroparesis
Truptesh H. Kothari*5, Christopher J. Lahr2, Charu Subramony3, Kristen V. Adams4, Lindsey Halley4, Austin R. Faulkner4, Joy Hughes4, Danielle C. Spree1, Thomas S. Helling2, Thomas L. Abell1
1Digestive Diseases, University of Mississippi Medical Center, Jackson, MS; 2Surgery, University of Mississippi, Jackson, MS; 3Pathology, University of Mississippi, Jackson, MS; 4School of Medicine, University of Mississippi, Jackson, MS; 5Gastroenterology/Hepatology, State University of New York Downstate Medical Center, Brooklyn, NY
Introduction: The muscular layers of stomach contain interstitial cells of Cajal (ICC) that stain with c-Kit (CD117) and nerve fibers that stain with S100. Cajal cell death is linked to gastroparesis (GP). Here we compared numbers of gastric nerve fibers and ICC in GP patients vs. controls.Methods: 103 GP patients (17M, 86F; 8-77 yrs, mean age 44.3 yrs; 34 diabetic and 69 idipathic) underwent permanent gastric electrical stimulator implantation, full-thickness gastric biopsy, and serosal and mucosal electrogastrography. Patient-reported GI symptoms were recorded at baseline and with treatment. S100 and CD117 staining and quantification of nerve fibers and interstitial cells of Cajal in inner and outer muscle layers of stomach were performed, and S100/CD117 ratios calculated. Ten high powered fields were examined and averaged for each layer (inner and outer) with each stain. Biopsy results were compared by two-tailed, un-paired t tests to results from 20 autopsy controls, also stained and counted. Means, medians, and ranges were calculated for all GP patients, controls, diabetic only, and idiopathic only. Results: Mean numbers of nerve fibers were significantly lower in GP patients than controls. Mean numbers of ICC were not reduced in the GP group. Ratios of S100/CD117 cells were decreased in GP patients.(Table 1)Conclusions: At histology, full thickness gastric biopsies of GP patients differed from controls. Quantification of gastric biopsies may help stratify patients prior to surgical, endoscopic or device therapies.
| Table 1 | Controls | All Pts | Diabetics (DM) | Idiopathic (ID) |
| S100 Outer Mean (SD) | 19.2 (11.9) | 8.1 (6.7) | 7.1 (5.2) | 8.5 (7.3) |
| Median | 14.8 | 6.1 | 6.5 | 6.1 |
| Range | 5.9-46.8 | 0.9-40 | 1-23.6 | 0.o-40 |
| p-Value vs. controls | 0.0015 | 0.0008 | 0.002 | |
| S100 Inner Mean (SD) | 25.9 (19.2) | 13.4 (9.5) | 14.7 (9.5) | 12.8 (9.6) |
| Median | 23.2 | 10.3 | 12.2 | 9.5 |
| Range | 8.8 88.3 | 2-46 | 3-42 | 2-46 |
| p-Value vs. controls | 0.017 | 0.034 | 0.014 | |
| CD 117 Outer Mean (SD) | 7.0 (6.5) | 6.8 (5.4) | 5.2 (3.8) | 7.5 (5.9) |
| Median | 4.4 | 5 | 4.4 | 5.4 |
| Range | 2026.7 | 0.9026 | 1018.2 | 0.9-26 |
| p-Value vs. controls | 0.88 | 0.27 | 0.7 | |
| CD 117 Inner Mean (SD) | 6.7 (3.3) | 10.3 (6.6) | 9.5 (6.0) | 10.7 (6.9) |
| Median | 5.8 | 8.5 | 8.9 | 8 |
| Range | 2.4-13.8 | 1-35 | 2-34.2 | 1-35 |
| p-Value vs. controls | 0.0005 | 0.028 | 0.0005 | |
| Inner S100/CD117 Ratio | 5.1 (5.8) | 1.7 (1.5) | 1.8 (1.1) | 1.7 (1.6) |
| Median | 3.5 | 1.4 | 1.6 | 1.1 |
| Range | 1.25.2 | 0.1-10 | 0.3-4.5 | 0.1-10 |
| p-Value vs. controls | 0.027 | 0.032 | 0.026 | |
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