S4487 Resolution of Refractory Gastroparesis Symptoms Following Benzodiazepine Treatment for Catatonia

Introduction: Gastroparesis is a motility disorder characterized by delayed gastric emptying without mechanical obstruction, causing abdominal pain, nausea, satiety, and bloating. Coexisting psychiatric conditions like anxiety and depression may compound gastrointestinal (GI) symptom severity. While neuromodulators for psychiatric conditions may be used off-label to treat gastroparesis symptoms, there is limited understanding of how treating coexisting psychiatric conditions affect GI symptoms. We present a case of refractory gastroparesis in which GI symptoms resolved after treatment for catatonic depression. Case Description: A 57-year-old woman with Sjogren’s syndrome and spasmodic dysphonia reported nausea/vomiting, satiety, and abdominal pain with poor oral intake and 30 lb weight loss which started after a viral illness and progressed over 7 months. Initially there were no psychiatric symptoms or signs of disordered eating. Abdominal computed tomography and magnetic resonance imaging were unremarkable. Gastric emptying study showed severe gastric emptying (44% at 4 hours). The patient trialed multiple medications. Esophagogastroduodenoscopy showed generalized gastritis. A nasojejunal tube was placed but after it clogged, she insisted on pursuing total parenteral nutrition (TPN). Gastric peroral endoscopic myotomy was performed. Four months post-procedure, she had ongoing GI symptoms and remained on TPN. She was admitted for planned gastrojejunal (GJ) tube placement and began to manifest increased anxiety and depression. She reported persecutory delusions and was diagnosed with major depressive disorder with psychosis complicated by catatonia. Medical management was initiated. Within 2 days, motor function, appetite, and GI symptoms began to improve. TPN was discontinued and GJ tube placement deferred. She was discharged to an inpatient psychiatric facility. Lorazepam was tapered over several months. Six months post-hospitalization, she remains free of GI symptoms. Discussion: Our case demonstrates improvement in gastroparesis symptoms after treatment of catatonic depression. Symptoms associated with gastroparesis can mimic or overlap with somatic symptoms of psychiatric disease. Of the <5 cases in the literature detailing gastroparesis treatment with benzodiazepines, none to our knowledge describe symptomatic resolution with psychiatric treatment. It is vital to appreciate the association between psychopathology and gastroparesis and consider treatment of psychiatric comorbidities particularly when symptoms are refractory to usual management.