Refractory gastroparesis: A case highlighting severe gastric motility dysfunction and innovative outpatient management

Gastroparesis is a gastrointestinal motility disorder characterized by delayed gastric emptying without mechanical obstruction. Diabetes mellitus is a common cause, with chronic hyperglycemia leading to autonomic neuropathy and impaired gastric motor function. Patients often present with persistent nausea, vomiting, early satiety, abdominal pain, and nutritional compromise. Severe diabetic gastroparesis can significantly affect quality of life and often requires specialized evaluation and multidisciplinary management.
We report a case of a young patient with long-standing diabetes mellitus who developed severe refractory gastroparesis. She experienced persistent nausea, vomiting, and inability to tolerate oral intake, resulting in prolonged and recurrent hospital admissions despite multiple pharmacological therapies.
Comprehensive investigations were performed to assess gastric motility and exclude structural causes. Diagnostic workup included upper gastrointestinal studies and gastric motility tests, confirming delayed gastric emptying consistent with severe gastroparesis. The patient was also evaluated for advanced interventions, including gastric peroral endoscopic myotomy (G-POEM), a minimally invasive procedure targeting pyloric dysfunction in refractory cases.
Despite optimized medical management, symptoms remained difficult to control, and safe discharge was challenging. A multidisciplinary team involving gastroenterology, pharmacy, and community healthcare services implemented an innovative home intravenous cyclizine therapy strategy. This approach enabled effective symptom control, facilitated safe discharge, and allowed the patient to regain a degree of independence and life outside the hospital environment.
This case underscores the importance of understanding gastrointestinal motility dysfunction in diabetic gastroparesis and highlights the role of multidisciplinary collaboration and innovative outpatient strategies in managing severe refractory cases. It demonstrates how careful evaluation and coordinated care can improve patient outcomes and quality of life in complex gastrointestinal disorders.