Abstract
A two-month-old developmentally normal full-term female presented with severe feeding intolerance, progressive weight loss, and persistent fussiness, leading to multiple emergency department visits and eventual hospitalization. Initial evaluations, including laboratory tests and imaging, were unremarkable, prompting a series of diagnostic and therapeutic interventions. A multidisciplinary approach, including empiric gastroesophageal reflux disease (GERD) therapy, was started. A gastric emptying study, upper GI, and endoscopy were done. She underwent gastrostomy tube (G-tube) placement, during which a gastric wall perforation was identified and managed intraoperatively. Multiple attempts at nutritional management, including nasoduodenal tube placement and total parenteral nutrition, were met with limited success. Gastroparesis and visceral hyperalgesia were suspected as underlying causes. Unlike previous cases documented in patients with a history of cardiac surgery, this neurologically normal patient had no such surgical history. A trial of gabapentin for possible visceral hyperalgesia resulted in a gradual improvement in oral tolerance and significant improvement with fussiness and discomfort. The patient was discharged at four months of age with gastrojejunal tube feeds and ongoing medical therapy. In this case, we highlight the utility of a gabapentin trial in an otherwise healthy patient. This case underscores the complexities of managing severe feeding disorders in infants, particularly the role of gabapentin in addressing suspected visceral hyperalgesia and failure to thrive in a patient without previous neurological or cardiac surgery.