The patient: A 63-year-old woman from Massachusetts faced significant health challenges.
The Symptoms and Initial Investigation
The symptoms: After enduring nausea and vomiting for a month, accompanied by a burning sensation in her abdomen and back, she presented to an emergency department. OTC acid reflux medications had proven ineffective, prompting further investigation. Frustratingly for the patient, her initial self-treatment did not alleviate her discomfort, highlighting a common issue: many patients struggle to differentiate between routine gastrointestinal troubles and more serious conditions that warrant medical evaluation.
With some research suggesting that upwards of 25% of patients visit emergency rooms for GI-related issues yearly, recognizing when symptoms escalate is vital. For this woman, the persistent nausea and pain flagged that additional scrutiny was needed, hinting at possible underlying conditions beyond typical reflux. This complexity often leads to delays in diagnosis, as patients frequently equate unexpected symptoms with common ailments.
Medical Background and Treatment Journey
The woman had a history of type 2 diabetes and obesity, having been prescribed semaglutide, a GLP-1 receptor agonist similar to Ozempic. Over the course of her treatment, she lost approximately 40 pounds (18 kilograms), with her weight loss accelerating notably in the past month. While weight loss can be a positive outcome when managing obesity, it also raises concerns, particularly with medications known to affect the gastrointestinal system.
Semaglutide and other GLP-1 medications work by increasing feelings of fullness and slowing stomach emptying, which can lead to marked weight loss. However, these effects also risk serious complications. If you're working in this space, keep in mind that while such medications can clearly benefit many, they can prompt unforeseen secondary health issues like the one experienced by this patient.
Diagnostic Process
What happened next: A CT scan of her abdomen and pelvis revealed slightly dilated bile ducts and a “heavy stool burden,” but there were no signs of obstructions. The scan indicated her stomach was distended due to what was identified as "semisolid material." To gain further clarity, doctors employed magnetic resonance cholangiopancreatography, which confirmed the dilated bile ducts and uncovered a mass in her stomach likely consisting of trapped air. An endoscopic examination followed to inspect her upper digestive tract.
Imaging studies can sometimes overwhelm, often revealing multiple issues that complicate understanding immediately. Accurate diagnosis can thus become a multi-step process of elimination. In this case, while CT and MRCP both pointed towards a physiological anomaly, it wasn't until the endoscopy that doctors identified the gastric bezoar causing her distress. Endoscopy remains a key tool for definitive diagnosis in suspected gastrointestinal blockages, allowing for direct visualization and intervention when necessary.
The Diagnosis: Gastric Bezoar
The diagnosis: The endoscopy identified a significant mass in the stomach termed a gastric bezoar, compacted clumps of indigestible or semi-digested material. Gastric bezoars, while rare, are an important entity in gastroenterology that can lead to complications if not addressed promptly.
Treatment Strategy
The treatment: Semaglutide, among other GLP-1 agents, is known to cause delayed gastric emptying, which can contribute to complications like bezoars. Upon her hospital admission, the medication was discontinued. One treatment strategy for dissolving a bezoar involves soda administration, which, although not thoroughly understood, may leverage acidity and carbonation.
Due to her diabetes, she was given diet cola. Her distaste for carbonated drinks led her to receive a reduced dosage of 1.5 liters (0.4 gallons) instead of the typical 3 liters (0.8 gallons). Remarkably, just a day into this treatment, she reported a "tugging" sensation in her abdomen, followed by significant alleviation of nausea and discomfort. A subsequent endoscopy confirmed the bezoar had cleared from her stomach.
This outcome highlights an often-overlooked aspect of medicine: the potential for less invasive treatments to yield significant benefits. Critical thinking about treatment options can lead to surprising results. While soda treatment for a gastric bezoar may seem unconventional, it illustrates the importance of patient-centered decision-making in medical treatments. Widespread application requires more data to endorse routinely, but in this case, it worked.
What Makes This Case Unique
Following this, she transitioned to a regular hospital diet and upon discharge experienced no nausea or abdominal pain. Although she did not resume semaglutide, she began a daily regimen of acid reflux medication. In the months after discharge, her appetite improved, and her weight stabilized without a return of her earlier symptoms.
What makes the case unique: Gastric bezoars are rarely encountered, appearing in less than 0.5% of upper digestive tract endoscopies. Their symptoms mimic those of various more common conditions, complicating diagnosis. This presents a diagnostic challenge for healthcare providers who often have to consider a wide range of differential diagnoses in an uncertain clinical context.
The prevalent type of bezoar stems from plant fibers, termed a "phytobezoar." Foods high in indigestible fibers, like persimmons, pineapples, and raisins, heighten the risk for individuals consuming them. However, other factors such as prior gastric surgeries, nerve damage, and certain medications that induce delayed gastric emptying can also increase susceptibility. In this instance, semaglutide likely predisposed the patient to develop a bezoar, which resolved after the medication was ceased.
Interestingly, the use of soda to treat the bezoar, while potentially surprising, aligns with current best practices that prioritize less invasive methods over endoscopic interventions.
“Bezoars formed from food material may be managed initially with oral administration of cola in patients who are clinically stable,” the report emphasized. This approach is not only cost-effective but also bears a lower complication risk than invasive procedures.
Implications and Future Outlook
Through this case, a broader understanding of gastric issues becomes apparent. Patients must be aware that medications, even seemingly benign ones like semaglutide, may have adverse effects. As the medical community continues to refine treatment protocols for weight management and diabetes, the complexities associated with such medications cannot be overlooked.
This case also emphasizes the importance of critically evaluating treatment modalities. While surgical and endoscopic options may be definitive, there's a growing trend toward embracing alternative strategies that mitigate risk. Moving ahead, we might see more research focusing on these less invasive treatments and their effectiveness in managing digestive complications.
For further intriguing medical scenarios, explore our Diagnostic Dilemma archives.
This article serves informational purposes only and should not be construed as medical advice.
This article was first published on October 15, 2025.
