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Protein Shakes: An Unusual Cause of Gastric Phytobezoar.

Klair JS, Girotra M, Dranoff JA, Aduli F - ACG Case Rep J (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

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A 35-year-old healthy man presented with gradually progressive abdominal pain and distention, nausea, vomiting, early satiety, and 4.5-kg weight gain over 3-4 months... Esophagogastroduodenoscopy (EGD) revealed a large gastric phytobezoar extending from gastric fundus to antrum (Figure 1)... He was started on papain, 1–2 tsp in 250 mL water by mouth 3 times per day, pineapple juice/cola to assist in dissolving bezoar, and metoclopramide to assist with gastric emptying... Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar (Figure 2)... They are usually asymptomatic, but can present with nausea, vomiting, abdominal pain, or, in severe cases, upper GI bleeding, gastric outlet obstruction, or perforation... Diagnostic techniques include abdominal films or CT to verify a filling defect and exclude perforation, barium studies to show contrast material coating the bezoar, and EGD to visualize the bezoar for diagnosis and therapy... We hypothesized that protein shakes were decreasing our patient's gastric emptying for long periods of time and precipitating bezoar formation... Protein takes longer to digest than carbohydrates, and this effect is more pronounced with casein powder, which digests very slowly... Dietary reference intake (DRI) recommends that the maximum amount of protein for most adults be around 0.8 g/kg body weight, which can be easily achieved with a balanced diet... No data exists on the safe amount of these protein supplements, and we call for further research on this subject... Financial disclosure: None to report... Informed consent was obtained for this case report... Previous Presentation: This case was presented as a poster at the ACG Annual Meeting; October 17-22, 2014; Philadelphia, Pennsylvania.

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Related in: MedlinePlus

Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar.
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Figure 2: Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar.

Mentions: A 35-year-old healthy man presented with gradually progressive abdominal pain and distention, nausea, vomiting, early satiety, and 4.5-kg weight gain over 3-4 months. His routine blood work, thyroid panel, ultrasound, and abdominal/pelvic CT were unremarkable. Esophagogastroduodenoscopy (EGD) revealed a large gastric phytobezoar extending from gastric fundus to antrum (Figure 1). The patient disclosed his passion for exercising, including an intense gym regimen and a high intake of protein shakes (3-4 per day) over the previous 6 months. While he expressed interest in surgical removal of the bezoar, he was counseled to try conservative measures. He was started on papain, 1–2 tsp in 250 mL water by mouth 3 times per day, pineapple juice/cola to assist in dissolving bezoar, and metoclopramide to assist with gastric emptying. Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar (Figure 2). His symptoms resolved, and he now avoids overuse of protein shakes.


Protein Shakes: An Unusual Cause of Gastric Phytobezoar.

Klair JS, Girotra M, Dranoff JA, Aduli F - ACG Case Rep J (2015)

Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508936&req=5

Figure 2: Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar.
Mentions: A 35-year-old healthy man presented with gradually progressive abdominal pain and distention, nausea, vomiting, early satiety, and 4.5-kg weight gain over 3-4 months. His routine blood work, thyroid panel, ultrasound, and abdominal/pelvic CT were unremarkable. Esophagogastroduodenoscopy (EGD) revealed a large gastric phytobezoar extending from gastric fundus to antrum (Figure 1). The patient disclosed his passion for exercising, including an intense gym regimen and a high intake of protein shakes (3-4 per day) over the previous 6 months. While he expressed interest in surgical removal of the bezoar, he was counseled to try conservative measures. He was started on papain, 1–2 tsp in 250 mL water by mouth 3 times per day, pineapple juice/cola to assist in dissolving bezoar, and metoclopramide to assist with gastric emptying. Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar (Figure 2). His symptoms resolved, and he now avoids overuse of protein shakes.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 35-year-old healthy man presented with gradually progressive abdominal pain and distention, nausea, vomiting, early satiety, and 4.5-kg weight gain over 3-4 months... Esophagogastroduodenoscopy (EGD) revealed a large gastric phytobezoar extending from gastric fundus to antrum (Figure 1)... He was started on papain, 1–2 tsp in 250 mL water by mouth 3 times per day, pineapple juice/cola to assist in dissolving bezoar, and metoclopramide to assist with gastric emptying... Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar (Figure 2)... They are usually asymptomatic, but can present with nausea, vomiting, abdominal pain, or, in severe cases, upper GI bleeding, gastric outlet obstruction, or perforation... Diagnostic techniques include abdominal films or CT to verify a filling defect and exclude perforation, barium studies to show contrast material coating the bezoar, and EGD to visualize the bezoar for diagnosis and therapy... We hypothesized that protein shakes were decreasing our patient's gastric emptying for long periods of time and precipitating bezoar formation... Protein takes longer to digest than carbohydrates, and this effect is more pronounced with casein powder, which digests very slowly... Dietary reference intake (DRI) recommends that the maximum amount of protein for most adults be around 0.8 g/kg body weight, which can be easily achieved with a balanced diet... No data exists on the safe amount of these protein supplements, and we call for further research on this subject... Financial disclosure: None to report... Informed consent was obtained for this case report... Previous Presentation: This case was presented as a poster at the ACG Annual Meeting; October 17-22, 2014; Philadelphia, Pennsylvania.

No MeSH data available.


Related in: MedlinePlus