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.

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, PLoS ONE), mice (Barthold et al., 2010), and dogs (Hodzic et al., 2014, AAC).

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.

Resources:

1. Qasawa, Austin H. BS  et al The American Journal of Gastroenterology 2025 – Unique Case of Gastroparesis in a Chronic Lyme Disease Patient
2. Embers ME, et al., 2012 – PLoS ONE: Showed Borrelia persistence in primates after standard treatment, with organisms found in multiple tissues.
3. Hodzic E, et al., 2014 – Antimicrob Agents Chemother: Demonstrated viable Borrelia in mice post-antibiotics, confirmed by PCR and xenodiagnosis (feeding ticks on treated animals).
4. Barthold SW, et al., 2010 – Am J Pathol: Documented persisting Borrelia organisms in mouse models despite treatment, suggesting incomplete bacterial clearance
5. Dr. Cameron’s blog –Lyme disease: a persistent infection
6. Dr. Cameron’s blog – Post-treatment Lyme may signal persistent infection