BACKGROUND: Bariatric surgery is related to significant morbidity. Mechanical complications such as stricture of the anastomotic sites are the most common causes of persistent nausea and vomiting. Some patients present such symptoms in the absence of these complications. AIM: To report the use of mirtazapine in a patient submitted to bariatric surgery, presenting persistent nausea and vomiting in the absence of mechanical complications, and unresponsive to conventional antiemetic drugs. CASE REPORT: A morbidly obese patient submitted to laparoscopic Roux-en-Y gastric bypass presented persistent nausea and vomiting unresponsive to treatment with ondansetron, metoclopramide, and bromopride. No mechanical complications were identified. He was treated with an oral daily dose of 30 mg of mirtazapine for 60 days. After two days, the patient presented significant clinical improvement. Mirtazapine is an effective drug most commonly used in the treatment of depression, presenting an antiemetic effect due to the blockade of 5-HT3 serotonin receptors in the brainstem. CONCLUSION: Mirtazapine can be useful in cases of Roux-en-Y gastric bypass that present nausea and vomiting unsuccessfully treated with conventional antiemetic drugs when mechanical causes are excluded.
Gastric bypass; Nausea; Vomiting; Morbid obesity; Mirtazepine