title: Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine.
abstract: We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management. This patient had no prior history of gastrointestinal symptoms. However, in the aftermath of a viral illness, she developed two months of intractable nausea, vomiting, and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances. A solid-phase gastric emptying scan had confirmed delayed emptying, confirming gastroparesis. Unfortunately, conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient's symptoms. At our institution, the patient experienced a cessation of vomiting, reported a significant reduction in nausea, and tolerated oral intake shortly after taking mirtazapine. Based on mirtazapine's primary action as a serotonin (5-HT) 1a receptor agonist, we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms. This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting. We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.
authors.affiliation: Shinjini Kundu, Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States.
authors.forename: Shinjini
authors.initials: S
authors.lastname: Kundu
authors.affiliation: Shinjini Kundu, Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States.
authors.forename: Shari
authors.initials: S
authors.lastname: Rogal
authors.affiliation: Shinjini Kundu, Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States.
authors.forename: Abdulkader
authors.initials: A
authors.lastname: Alam
authors.affiliation: Shinjini Kundu, Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: Levinthal
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D009325:Nausea / Q000188:drug therapy; D058829:Serotonin 5-HT1 Receptor Antagonists / Q000627:therapeutic use; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications*; D014839:Vomiting / Q000188:drug therapy
chemical_list: D000317:Adrenergic alpha-Antagonists; D000932:Antiemetics; D058829:Serotonin 5-HT1 Receptor Antagonists; D008803:Mianserin; D000078785:Mirtazapine
keywords: Anti-emetics; Gastroparesis; Mirtazapine; Nausea; Symptoms; Vomiting