Case Report
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World J Gastroenterol. Jun 7, 2014; 20(21): 6671-6674
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6671
Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine
Shinjini Kundu, Shari Rogal, Abdulkader Alam, David J Levinthal
Shinjini Kundu, Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States
Shari Rogal, David J Levinthal, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Abdulkader Alam, Department of Psychiatry, Stony Brook University Hospital, Stony Brook, NY 11794, United States
Author contributions: Kundu S, Rogal S, Alam A and Levinthal DJ designed the report and collected the patient’s clinical data; Kundu S, Rogal S and Levinthal DJ analyzed the data and wrote the paper.
Supported by University of Pittsburgh Medical Center, Pittsburgh PA, United States
Correspondence to: David J Levinthal, MD, PhD, Assistant Professor of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, M2 C-Wing PUH, 200 Lothrop Street, Pittsburgh, PA 15213, United States. levinthald@upmc.edu
Telephone: +1-412-3030525 Fax: +1-412-648-9378
Received: October 22, 2013
Revised: January 10, 2014
Accepted: March 5, 2014
Published online: June 7, 2014
Processing time: 226 Days and 20 Hours
Abstract

We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management. This patient had no prior history of gastrointestinal symptoms. However, in the aftermath of a viral illness, she developed two months of intractable nausea, vomiting, and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances. A solid-phase gastric emptying scan had confirmed delayed emptying, confirming gastroparesis. Unfortunately, conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms. At our institution, the patient experienced a cessation of vomiting, reported a significant reduction in nausea, and tolerated oral intake shortly after taking mirtazapine. Based on mirtazapine’s primary action as a serotonin (5-HT) 1a receptor agonist, we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms. This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting. We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.

Keywords: Nausea; Vomiting; Gastroparesis; Symptoms; Mirtazapine; Anti-emetics

Core tip: The management of symptoms associated with severe gastroparesis remains challenging because current therapeutic options are fairly limited. This case report documents the rapid improvement of nausea and vomiting in a patient with severe post-infectious gastroparesis with mirtazapine. Because mirtazapine acts primarily as a serotonin 1a receptor agonist, this receptor system may be an important adjunctive target for nausea and vomiting refractory to standard therapies. Thus, mirtazapine should be considered as a treatment option for gastroparesis.