Soft drinks might be employed to break down “bezoars,” often sizable accumulations of indigested sustenance within the belly.(Image credit: bhofack2 via Getty Images)
The individual: A 63 year-old female located in Massachusetts
The indications: The individual visited the emergency area subsequent to enduring sickness and regurgitation for nearly a month, along with diminished desire for food. She reported to physicians that she had additionally felt a searing ache within her upper belly and right facet of her body, which extended toward her posterior. She had attempted handling these indications utilizing two typical nonprescription remedies for heartburn, though these treatments did not yield results.
During the preceding year, the individual had commenced utilizing semaglutide, a medication categorized as a GLP-1 receptor agonist — belonging to the identical pharmacological classification as Ozempic. These injectable medications are administered for handling type 2 diabetes and facilitating ongoing weight regulation; within this instance, the woman possessed prior instances of type 2 diabetes and obesity. Subsequent to initiating the medication, she had shed approximately 40 pounds (18 kilograms); nevertheless, it’s worth noting that this reduction in weight had become more pronounced throughout the earlier month, as she indicated.
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Subsequent events: Doctors performed a CT examination of the patient’s abdomen and pelvic region. This examination indicated that the bile passages, responsible for conveying bile from the liver toward the gallbladder and the small intestine, were somewhat expanded. The woman additionally exhibited a “significant fecal load” devoid of any indications of obstructions within her intestines, alongside a marginally extended stomach resulting from the presence of “semisolid substance.”
To acquire a more detailed perspective, the medical personnel then utilized magnetic resonance cholangiopancreatography, a non-intrusive assessment technique for examining the bile channels, gallbladder, pancreas, and pancreatic channels. The assessment validated the dilation of the bile passages and detected a mass situated within the stomach, seemingly containing confined air. Subsequently, the doctors scrutinized the upper segment of the gastrointestinal system, encompassing the esophagus and the initial section of the small intestine, through the utilization of an endoscope.
The identified condition: The endoscopy procedure revealed a substantial accumulation within the woman’s stomach, diagnosed as a gastric bezoar. These collections consist of firmly compacted masses composed of partially processed or unprocessed elements.
The therapy: Semaglutide along with alternative GLP-1 agonists commonly induce a deceleration of gastric emptying, leading to a reduction in the velocity at which the stomach discharges its contents toward the intestines. Upon the woman’s admission into the medical facility, her usage of this medication was ceased.
The subsequent measure for addressing a bezoar entails endeavors to disintegrate the mass while it remains localized within the stomach — and available data implies that the administration of soda to the patient represents an effective methodology for accomplishing this.
“Existing evidence, predominantly derived from collections of case studies and anecdotal accounts, lends support to the delivery of 3 liters [0.8 gallons] of cola, either via oral consumption or through insertion via a nasogastric tube, spanning a period of 12 hours,” physicians documented in a report pertaining to the instance. “The precise mechanisms responsible for the dissolution of the bezoar, encompassing acidity, carbonation, or other contributors, remain incompletely elucidated.”
Considering the patient’s medical history of diabetes, she received diet cola. Furthermore, due to her aversion to carbonated refreshments, the customary prescription of 3 liters of soda was diminished to 1.5 liters (0.4 gallons). On the subsequent day after commencing this regimen, the patient detected a “tugging” sensation within her abdominal region, succeeded by a alleviation of both her nausea and abdominal unease. An examination via endoscopy substantiated that the bezoar had been eradicated from her stomach.
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Subsequently, the woman was transitioned to a standard dietary plan within the medical facility, and by the time of her discharge, she exhibited no further instances of nausea, vomiting, or abdominal discomfort. She did not recommence semaglutide usage but received a prescription for routine consumption of heartburn medication. She conveyed an escalation in her appetite post-discharge from the medical facility, accompanied by a modest resurgence in her weight throughout the subsequent months. Her abdominal symptoms did not recur within a timespan of several months following discharge.
Elements that render this instance exceptional: Gastric bezoars arise with relative infrequency, as highlighted in the report. They manifest in less than 0.5% of endoscopic examinations conducted on the superior segment of the digestive system. The prevalence of symptoms indicative of the condition, encompassing pain, nausea, vomiting, and abdominal unease, are additionally observed in an array of more prevalent ailments; hence, their existence does not invariably signify the presence of a bezoar in all situations.
The most frequently encountered variant of gastric bezoar originates from plant-based fibers and is referred to as a “phytobezoar.” Heightened consumption of particular comestibles, such as persimmons, pineapples, raisins, or celery, may augment the susceptibility to phytobezoars due to the elevated concentration of indigestible constituents inherent in these plants, encompassing cellulose, lignins, and specific tannins.
Nevertheless, diverse medical conditions, interventions, and pharmacological agents may similarly amplify the risk of bezoars. These encompass anatomical variances stemming from bariatric or alternative gastric surgical procedures, autonomic nerve impairment, and medications conducive to retarded gastric drainage, exemplified by GLP-1s. In the context of the woman’s case, the administration of semaglutide most likely served as the causative factor behind her bezoar, and the discontinuation of this treatment facilitated the resolution of the matter.
OTHER DILEMMAS
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The cola she ingested likewise played a role. While this treatment approach might appear unorthodox when expressed on paper, it represents the favored initial strategy, superseding the utilization of a scope for the physical disruption of the bezoar residing within the patient’s stomach.
“Bezoars originating from alimentary material may initially undergo management through the oral delivery of cola to patients presenting with a clinically stable state,” as articulated within the report. “This specific intervention generally proves economical and entails a reduced incidence of complications when juxtaposed against invasive methodologies.”
For additional enthralling medical cases, explore our Diagnostic Dilemma archives.
Disclaimer
This article is solely intended to furnish information and is not intended to constitute medical advice.
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Nicoletta LaneseSocial Links NavigationChannel Editor, Health
Nicoletta Lanese serves as the health channel editor at Live Science and has formerly held roles as a news editor and staff writer at the same platform. She possesses a graduate certification in science communication conferred by UC Santa Cruz, along with degrees in neuroscience and dance acquired from the University of Florida. Her scholarly endeavors have found publication in entities such as The Scientist, Science News, the Mercury News, Mongabay, and Stanford Medicine Magazine, among other channels. Residing in NYC, she actively participates in dance and collaborates on endeavors initiated by local choreographers.
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