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. CASE PRESENTATION: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. CASE MANAGEMENT: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. CASE OUTCOME: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.

journal_name

Palliat Med

journal_title

Palliative medicine

authors

Franco M,Koulaeva E

doi

10.1177/0269216314528400

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

986-989

issue

7

eissn

0269-2163

issn

1477-030X

pii

0269216314528400

journal_volume

28

pub_type

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