Lyme Disease and Gastroparesis: When the Diagnosis Is Missed

Lyme disease gastroparesis is rarely recognized—but may be an underappreciated complication of tick-borne illness.

In a case reported by Qasawa and colleagues, a young woman with chronic Lyme disease developed severe gastrointestinal dysfunction requiring intravenous nutrition. :contentReference[oaicite:0]{index=0}

Key issue: despite multisystem illness, Lyme disease was not reconsidered as a treatable cause.

A Severe and Progressive Illness

A 25-year-old woman with a history of chronic Lyme disease, Ehlers-Danlos syndrome, and seizure disorder developed worsening gastrointestinal symptoms.

Her illness began with loss of appetite, followed by:

• Persistent nausea and vomiting
• Gagging and reflux
• Inability to tolerate solid food

Her condition progressed despite interventions.

The gallbladder was removed due to inflammation—but relief was temporary.

Clinical pattern: symptoms persisted despite multiple interventions.

From Feeding Tube to IV Nutrition

As her condition worsened:

• A feeding tube was placed into the small intestine
• Nutritional support remained inadequate
• She ultimately required total parenteral nutrition (TPN)

Imaging confirmed delayed gastric and small bowel emptying, consistent with gastroparesis.

Impact: the patient became dependent on IV nutrition for survival.

The Missed Opportunity

Despite the complexity of her illness, clinicians did not pursue antibiotic retreatment for Lyme disease or evaluate for co-infections.

Her condition was attributed to “inflammatory neuropathy.”

Clinical concern: premature diagnostic closure may have limited treatment options.

[bctt tweet=”Severe gastroparesis in Lyme disease may be overlooked when clinicians stop considering infection as a cause.” username=”DrDanielCameron”]

Can Lyme Disease Affect the Gut?

Lyme disease is known to affect the nervous system.

Autonomic dysfunction and neuropathy can disrupt gastrointestinal motility.

Clinical implication: gastroparesis may reflect neurologic involvement rather than isolated GI disease.

Persistent Infection: An Ongoing Debate

Some research suggests that Borrelia burgdorferi may persist after standard treatment in animal models.

This raises important questions about symptom persistence and treatment strategies in complex cases.

Clinical reality: the role of persistent infection remains an area of active investigation.

Why This Case Matters

This case illustrates how multisystem symptoms can be attributed to irreversible damage rather than potentially treatable causes.

Clinical pattern: once a diagnosis is labeled “chronic,” treatment options may narrow prematurely.

As a result, patients may be managed supportively without reconsidering underlying mechanisms.

Clinical Takeaway

Lyme disease gastroparesis may represent an underrecognized manifestation of neurologic involvement.

When symptoms are severe, progressive, and unexplained, clinicians should reassess the diagnosis and consider all potential contributors—including infection.

Key question: Could some cases of “idiopathic” gastroparesis have an infectious origin?

For more, see Lyme disease: a persistent infection.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention