Gastrointestinal Lyme Disease and Gastroparesis
Gastrointestinal Lyme disease symptoms may occur when the infection affects the autonomic nervous system. Patients may develop nausea, vomiting, abdominal pain, reflux, and delayed stomach emptying known as gastroparesis.
In their article, “Unique Case of Gastroparesis in a Chronic Lyme Disease Patient,” Qasawa et al. discuss the case of a patient diagnosed with chronic Lyme disease who developed severe gastrointestinal complications including gastroparesis.
Her symptoms became so severe that she required intravenous nutrition to maintain her weight—making gastroparesis an important Lyme disease symptom that deserves clinical consideration.
The case highlights a critical diagnostic oversight. Even though her illness affected multiple systems in her body—as is often seen in Lyme disease—doctors never considered retreating her with antibiotics for Lyme disease or evaluating possible co-infections.
Can Lyme Disease Cause Stomach Pain?
Yes. Some patients with gastrointestinal Lyme disease develop abdominal pain, nausea, vomiting, bloating, and difficulty tolerating food. These symptoms may occur when Lyme disease disrupts the autonomic nervous system, which controls digestive motility.
Autonomic nerve dysfunction can impair the stomach’s ability to move food normally through the digestive tract, producing delayed gastric emptying known as gastroparesis.
Woman with Lyme Disease and Gastroparesis
A 25-year-old woman living with chronic Lyme disease, Ehlers-Danlos Syndrome, and a seizure disorder struggled with ongoing health problems that led to severe weight loss and difficulty getting enough nutrition.
Her illness first appeared as a loss of appetite. Doctors removed her gallbladder because it was inflamed, but the surgery provided only temporary relief.
Soon afterward her symptoms returned. She developed constant nausea, vomiting, gagging, heartburn, and frequent regurgitation. Eating became so difficult that she could no longer tolerate solid foods.
Doctors placed a feeding tube into her small intestine, but this offered little improvement. Eventually, she required intravenous nutrition—called total parenteral nutrition (TPN)—to maintain her weight.
Special imaging studies showed her stomach and small intestine were emptying much more slowly than normal, while her large intestine functioned normally.
She was given several medications to help manage symptoms, including treatments for nausea, reflux, bloating, and digestion. However, at no point was she treated with antibiotics for Lyme disease or possible related infections.
Discussion
Lyme disease, caused by Borrelia burgdorferi, most commonly affects the musculoskeletal, cardiovascular, and nervous systems. Gastrointestinal manifestations such as gastroparesis are rarely reported but may occur when infection affects autonomic nerve function.
In this case, severe dysmotility and progressive multisystem symptoms were attributed solely to “inflammatory neuropathy.” This interpretation led to premature diagnostic closure and omission of antimicrobial therapy.
A growing body of evidence suggests that Borrelia burgdorferi may persist after standard treatment. Animal studies have demonstrated viable organisms in primates (Embers et al., 2012), mice (Barthold et al., 2010), and dogs (Hodzic et al., 2014).
By assuming irreversible nerve damage and neglecting the possibility of persistent infection, clinicians may miss opportunities to consider antimicrobial therapy that could potentially alter the trajectory of disease.
Instead, this patient remained dependent on TPN, a life-sustaining but non-curative intervention.
This case underscores the importance of considering persistent infection or autonomic dysfunction when evaluating complex multisystem manifestations of Lyme disease.
Clinical Takeaway
This case demonstrates how gastrointestinal complications of Lyme disease can become severe enough to require intravenous nutrition. When Lyme disease affects autonomic nerves that regulate digestive motility, patients may develop profound gastroparesis with nausea, vomiting, and difficulty maintaining adequate nutrition.
Recognizing gastrointestinal Lyme disease symptoms may help clinicians consider Lyme disease in patients with unexplained dysmotility and relevant exposure history.
Frequently Asked Questions
Can Lyme disease cause gastroparesis?
Yes. Lyme disease can affect the autonomic nervous system controlling gut motility, leading to gastroparesis where the stomach empties much more slowly than normal.
Why wasn’t this patient retreated with antibiotics?
Clinicians attributed her symptoms solely to inflammatory neuropathy and assumed irreversible nerve damage, rather than considering persistent Borrelia infection that might respond to antimicrobial therapy.
Can Lyme disease persist after standard antibiotic treatment?
Evidence from animal studies suggests Borrelia may persist after standard treatment, with viable organisms demonstrated in primates, mice, and dogs following antibiotic therapy.
Related Reading
Lyme Disease Symptoms: What Patients Need to Know
Can Lyme Disease Cause Diarrhea? GI Symptoms Explained
Lyme Disease Gut Symptoms: 7 Clues Your Doctor May Miss
Autonomic Dysfunction in Lyme Disease
Post-Treatment Lyme Disease Syndrome (PTLDS)
Medical Dismissal in Lyme Disease
References
- Qasawa AH, et al. Unique case of gastroparesis in a chronic Lyme disease patient. Am J Gastroenterol. 2020;115:S1473.
- Embers ME, et al. Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment. PLoS One. 2012.
- Hodzic E, et al. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrob Agents Chemother.
- Barthold SW, et al. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi.
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
In 1999, my 7yo daughter had a known tick attachment. First symptom were persistent ankle pain At age 8, she had chronic constipation, resulting in 4 trips to ER and 2 overnight hospital admissions. More water and fiber were not effective remedies. At puberty at 12, her health collapsed. She had two Lyme bands and got IV treatment Tilt table at 14 got POTS dx. At 28yo, she remains disabled.
You are not alone. This article on autonomic dysfunction affords some insight into the potential role of autonomic dysfunction in Lyme disease.
I have had chronic Lyme for 4 yrs with terrible digestive problems.
I self diagnosed myself with Lymes after no one seemed to be able to figure it out. I had a total of 24 days of doxycycline and was pronounced cured. I originally had severe back pain in my right kidney area that has decreased significantly but still have a burning sensation in the left front flank area where my intestines are along with some joint pain. I’m taking Meloxicam for pain. I’ve been extremely tired and can’t seem to stay awake when in a vehicle. I don’t feel I’m over it and wondering if I’m ever going to feel normal again.
I have Lyme disease patients who are better in 24 days if they get treated at the time of a rash. I have patients who have failed 24 days who benefit from further treatment for Lyme and coinfections.