Mirtazapine: a solution for postoperative gastroparesis?

Abstract

This report describes the case of a 52-year-old man with an obstructed para-oesophageal hiatus hernia who required a gastropexy, who postoperatively developed gastroparesis which inadequately responded to conventional prokinetics including erythromycin, metoclopramide, ondansetron, and domperidone. The patient's symptoms were relieved rapidly with a trial of mirtazapine. A review of related literature is presented.

Recent Advances in the Pathophysiology and Treatment of Gastroparesis

“…Ondansetron, a 5-HT 3 receptor antagonist, is effective in controlling nausea and vomiting, but has not been shown to improve gastric emptying 61. Mirtazapine is an antidepressant that is active on the 5-HT 3 receptor; it has been used for the treatment of nausea in patients with gastroparesis refractory to conventional prokinetic therapies 62,63. Tricyclic antidepressants (TCAs) are efficacious in functional nausea and vomiting and irritable bowel syndrome 64,65.…”

Mirtazapine treatment of diabetic gastroparesis as a novel method to reduce tube-feed residual: a case report

“…After review of the literature for non-invasive therapies to manage recalcitrant gastroparesis, two reports of success with mirtazapine were found. One case report involved a patient with post-gastropexy-related recalcitrant gastroparesis that promptly resolved with mirtazapine [10]. In another report, a 27-year-old woman with diabetes type 1 and gastroparesis recalcitrant to seven months of therapy with all known medication regimen and botulinum toxin injections, had resolution of her symptoms within one week of therapy with 15mg of mirtazapine [11].…”

Symptomatic Management for Gastroparesis

“…32 Likewise, 3 months of mirtazapine 15 mg nightly reduced nausea and vomiting and promoted adequate oral intake in a 52-year-old man with postsurgical gastroparesis. 33 Mirtazapine 30 mg similarly evoked significant antiemetic actions with associated weight gain and improved oral intake in a 34-year-old woman with postinfectious gastroparesis. 34 Mirtazapine has not been investigated in gastroparesis in a controlled fashion, but a preliminary study was reported for functional dyspepsia.…”