Can Lyme Disease Cause Gastroparesis? A Severe Case

Severe nausea, vomiting, and delayed stomach emptying
Possible autonomic nervous system involvement
A patient ultimately required IV nutrition

Can Lyme disease cause gastroparesis? In their article, “Unique Case of Gastroparesis in a Chronic Lyme Disease Patient,” Qasawa and colleagues describe a patient diagnosed with chronic Lyme disease who developed severe gastrointestinal complications, including markedly delayed stomach emptying.

Although uncommon, gastroparesis represents one of the most severe gastrointestinal complications reported in association with Lyme disease.

Lyme disease may be associated with gastrointestinal symptoms such as nausea, vomiting, loss of appetite, reflux, abdominal discomfort, constipation, and diarrhea. Gastroparesis appears to be a rarely reported manifestation, but it can become severe when the stomach cannot move food normally through the digestive tract.

In this case, the patient’s symptoms became so severe that she required intravenous nutrition to maintain her weight. The report illustrates why gastroparesis deserves consideration when evaluating unexplained Lyme disease symptoms involving multiple body systems.

Case Report: Woman With Lyme Disease and Gastroparesis

A 25-year-old woman with a history of chronic Lyme disease, Ehlers-Danlos syndrome, and a seizure disorder developed progressive gastrointestinal symptoms, severe weight loss, and difficulty obtaining enough nutrition.

Her illness initially presented with a loss of appetite. Doctors removed her gallbladder after finding inflammation, but the procedure provided only temporary relief.

Her symptoms soon returned. She experienced persistent nausea, vomiting, gagging, heartburn, and frequent regurgitation. Eating became increasingly difficult, and she eventually could no longer tolerate solid food.

Doctors placed a feeding tube into her small intestine, but it provided little improvement. She ultimately required total parenteral nutrition, or TPN, which delivers nutrition intravenously and bypasses the gastrointestinal tract.

Specialized testing showed that her stomach and small intestine emptied much more slowly than normal. Her large intestine continued to function normally.

She received several medications intended to manage nausea, acid reflux, bloating, and impaired digestion. According to the case report, however, she was not treated again with antibiotics for Lyme disease or evaluated for antimicrobial treatment directed at possible co-infections.

How Gastroparesis Affects Digestion

Gastroparesis occurs when the stomach empties more slowly than expected even though there is no physical obstruction blocking the passage of food. Common symptoms include nausea, vomiting, feeling full after eating only a small amount, bloating, reflux, abdominal discomfort, and difficulty maintaining weight.

Some patients with delayed gastric emptying experience nausea shortly after eating, early fullness, bloating, regurgitation, or vomiting after meals.

The stomach depends on coordinated signals from the autonomic nervous system, including the vagus nerve, to move food into the small intestine. Injury or dysfunction affecting these pathways can interfere with normal gastric motility.

Gastroparesis may represent one form of gastrointestinal dysautonomia. It can overlap with other autonomic symptoms, including orthostatic intolerance, heart-rate changes, abnormal sweating, difficulty regulating blood pressure, and postural orthostatic tachycardia syndrome, or POTS.

This provides one possible explanation for an association between Lyme disease and gastroparesis. Lyme disease can involve the nervous system, and some patients develop symptoms consistent with autonomic dysfunction, including dizziness, heart-rate changes, abnormal sweating, gastrointestinal dysmotility, and difficulty regulating blood pressure.

However, a single case report cannot establish that Lyme disease directly caused this patient’s gastroparesis. Her Ehlers-Danlos syndrome, seizure disorder, medications, prior gallbladder disease, inflammatory neuropathy, and other possible causes also needed to be considered.

Can Lyme Disease Cause Nausea and Vomiting?

Nausea and vomiting are not usually considered the defining symptoms of Lyme disease, but they may occur in some patients. Possible explanations include autonomic dysfunction, medication side effects, another tick-borne infection, gallbladder or gastrointestinal disease, and an unrelated medical condition.

Symptoms such as repeated vomiting, inability to tolerate food or liquids, progressive weight loss, severe abdominal pain, blood in the vomit or stool, or signs of dehydration require prompt medical evaluation. These symptoms should not automatically be attributed to Lyme disease.

For patients with persistent nausea, reflux, early fullness, or vomiting after meals, clinicians may consider testing for delayed gastric emptying along with a broader evaluation for gastrointestinal, neurologic, metabolic, medication-related, and structural causes.

Persistent Symptoms and the Question of Ongoing Infection

Lyme disease typically affects the musculoskeletal, cardiovascular, and nervous systems. Gastrointestinal manifestations such as severe gastroparesis have been reported far less often.

In this case, the authors attributed the patient’s severe dysmotility to inflammatory neuropathy. The report cannot determine whether persistent Borrelia burgdorferi infection contributed to her illness because additional antimicrobial therapy was not reconsidered.

Experimental animal studies have raised questions about what may remain after antibiotic treatment. Researchers have reported evidence of persistent organisms or non-cultivable spirochetal forms in treated rhesus macaques and mouse models. The clinical significance of these animal findings for individual patients with ongoing symptoms remains uncertain.

Because antimicrobial therapy for Lyme disease or possible co-infections was not reconsidered in this case, it remains unknown whether additional treatment might have altered the course of her illness.

The patient remained dependent on TPN, a life-sustaining intervention that supplied nutrition but did not correct the underlying cause of her gastrointestinal dysmotility.

This case underscores the importance of maintaining a broad differential diagnosis when a patient with a history of Lyme disease develops severe, progressive, or unexplained gastrointestinal symptoms.

Frequently Asked Questions

Can Lyme disease cause gastroparesis?

Gastroparesis has been described in patients with Lyme disease, but it appears to be rare. Lyme disease may affect autonomic nerve pathways involved in stomach motility, although a case report alone cannot prove that Lyme disease caused the delayed gastric emptying.

Can Lyme disease cause nausea and vomiting?

Some patients with Lyme disease report nausea or vomiting. These symptoms may be related to autonomic dysfunction, another tick-borne infection, medication side effects, or an unrelated gastrointestinal condition. Persistent or severe vomiting requires a broader medical evaluation.

Can Lyme disease cause nausea after eating?

Delayed stomach emptying can cause nausea shortly after eating, early fullness, bloating, regurgitation, or vomiting after meals. These symptoms may have several causes and should be evaluated rather than automatically attributed to Lyme disease.

Can Lyme disease cause stomach and digestive problems?

Lyme disease may be associated with gastrointestinal symptoms such as nausea, reflux, abdominal discomfort, constipation, diarrhea, early fullness, and impaired motility. Clinicians should also investigate other common gastrointestinal, neurologic, metabolic, and medication-related causes.

Why was this patient not retreated with antibiotics?

The case report states that her symptoms were attributed to inflammatory neuropathy and managed with nutritional support and medications directed at gastrointestinal symptoms. It remains unknown whether additional antimicrobial treatment would have changed her outcome.

Clinical Takeaway

This case describes a patient with Lyme disease and severe gastroparesis marked by nausea, vomiting, reflux, delayed stomach and small-intestinal emptying, progressive weight loss, and an eventual need for intravenous nutrition.

Gastroparesis may involve autonomic nerve pathways that regulate digestion, but other causes must also be investigated. The report does not establish whether persistent infection caused the patient’s gastrointestinal illness or whether additional antimicrobial therapy would have changed the outcome.

Severe or progressive gastrointestinal symptoms in a patient with Lyme disease warrant a broad evaluation that considers autonomic dysfunction, possible tick-borne co-infections, treatment effects, and unrelated gastrointestinal disease.

Related Articles

These articles provide additional information about gastrointestinal symptoms, persistent illness, and recovery from Lyme disease:

Can Lyme Disease Cause Diarrhea? GI Symptoms Explained
Lyme Disease Gut Symptoms: 7 Clues Your Doctor May Miss
Persistent Lyme Disease: Symptoms, Evidence, and Treatment Questions
Recovery From Lyme Disease: Why Improvement Can Take Time

References

1. Qasawa AH, Pietrowsky T, Jafri SM. Unique case of gastroparesis in a chronic Lyme disease patient. American Journal of Gastroenterology. 2020;115:S1473.
2. Embers ME, Barthold SW, Borda JT, et al. Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection. PLoS One. 2012;7(1):e29914.
3. Hodzic E, Feng S, Holden K, Freet KJ, Barthold SW. Persistence of Borrelia burgdorferi following antibiotic treatment in mice. Antimicrobial Agents and Chemotherapy. 2008;52(5):1728–1736.
4. Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, Luft BJ. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrobial Agents and Chemotherapy. 2010;54(2):643–651.

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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