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 suffered from gastrointestinal complications including gastroparesis.

Her symptoms were so severe that she required IV nutrition to maintain her weight—making gastroparesis an important Lyme disease symptom that deserves consideration.

The case highlights a critical diagnostic oversight: Even though her illness affected multiple systems in her body (as seen with Lyme disease), doctors never considered retreating her with antibiotics for Lyme disease or possible co-infections.

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 showed up as a loss of appetite. Doctors removed her gallbladder because it was inflamed, but this only gave short-term relief.

Soon after, her symptoms returned—she began experiencing 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 needed intravenous nutrition (called total parenteral nutrition, or TPN) to keep her weight stable.

Special imaging studies showed her stomach and small intestine were emptying much more slowly than normal, while her large intestine was working normally.

She was given several medications to help manage symptoms, including those 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, typically affects the musculoskeletal, cardiovascular, and central nervous systems. Gastrointestinal manifestations such as gastroparesis are rarely reported in the literature.

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 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 persistent infection, this patient’s clinicians missed an opportunity for antibiotic therapy that might have altered the trajectory of her disease.

Instead, she remains dependent on TPN, a life-sustaining but non-curative intervention.

This case underscores the importance of considering persistent infection when managing complex manifestations of Lyme disease.

Clinical Takeaway

This case demonstrates how gastroparesis in Lyme disease can be severe enough to require IV nutrition, yet clinicians attributed symptoms solely to “inflammatory neuropathy” without considering persistent infection or antimicrobial therapy. A growing body of evidence shows Borrelia may persist after standard treatment—animal studies demonstrate viable organisms in primates, mice, and dogs post-treatment. By assuming irreversible nerve damage and neglecting persistent infection, clinicians missed an opportunity for antibiotic therapy that might have altered disease trajectory, leaving the patient dependent on TPN rather than addressing the underlying infection.

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 post-treatment.

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

1. Qasawa AH, et al. Unique case of gastroparesis in a chronic Lyme disease patient. Am J Gastroenterol. 2020;115:S1473.
2. Embers ME, et al. Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection. PLoS One. 2012;7(1):e29914.
3. Hodzic E, et al. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrob Agents Chemother. 2008;52(5):1728–1736.
4. Barthold SW, et al. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrob Agents Chemother. 2010;54(2):643–651.