title: Nasogastric tube insertion followed by intravenous and oral erythromycin in refractory nausea and vomiting secondary to paraneoplastic gastroparesis: A case report.
abstract: BACKGROUND
  Gastroparesis is an under-recognised cause of refractory nausea and vomiting in patients with malignancy. The most common aetiologies are paraneoplastic and postsurgical dysmotility. There are little data on the efficacy of treatment to direct the management of patients with this symptom. We present a case and brief summary of current literature.
  
  
  METHODS
  We present the case of a 72-year-old patient with metastatic neuroendocrine carcinoma of the pancreas with dehydration and renal impairment secondary to nausea and vomiting. Replacement of duodenal stent, gastroscopy, endoscopic retrograde cholangiopancreatogram and gastric motility studies revealed gastroparesis rather than mechanical obstruction.
  
  
  RESULTS
  The patient was transferred to an inpatient palliative care unit for symptom management where a nasogastric tube was inserted, followed by intravenous erythromycin with excellent improvement in symptoms and oral intake. He was switched to oral erythromycin with ongoing effect.
  
  
  METHODS
  With stabilisation of symptoms and renal function, the patient was able to be discharged with maintenance of good symptomatic control.
  
  
  CONCLUSIONS
  Further research is needed into the management of gastroparesis in palliative care patients. In particular, we suggest that initial drainage with a nasogastric tube followed by a course of erythromycin warrants further study.
authors.affiliation: Palliative and Supportive Care Unit, Monash Medical Centre Clayton, Monash Health, Clayton, VIC, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia michael.franco@monash.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Franco
authors.affiliation: Monash Health, Clayton, VIC, Australia.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Koulaeva
keywords: Gastroparesis; erythromycin; nausea; palliative medicine; vomiting