Treating a Stomach Bezoar
A patient had a stomach bezoar successfully dissolved by doctors using diet cola. The bezoar formed as a result of taking semaglutide, a GLP-1 receptor agonist, which the patient had been using for the past year to manage type 2 diabetes and obesity. Over that period, she lost approximately 18 kilograms, with weight loss accelerating in the final month. However, CT scans and magnetic resonance cholangiopancreatography revealed dilated bile ducts and a distended stomach.
The Treatment Process
During a follow-up endoscopic examination, doctors discovered a large, dense mass—a gastric bezoar, a condition that occurs in fewer than 0.5% of endoscopic procedures. The medical team concluded that semaglutide, which slows gastric emptying, was the cause, so they decided to discontinue the medication. To break down the bezoar, they employed an unconventional yet officially recognized method: using a carbonated soft drink.
Standard practice involves administering 3 liters of cola either orally or through a tube over 12 hours. In this case, however, the patient was prescribed only 1.5 liters of diet cola—half the usual amount—due to her diabetes and aversion to carbonated beverages. By the second day of treatment, her nausea and discomfort had subsided, and a repeat endoscopy confirmed that the bezoar had fully dissolved.
The patient was discharged after returning to a normal diet. Over several months of follow-up, the symptoms did not recur, and her weight stabilized. Attempts to manage the symptoms on her own with standard over-the-counter heartburn remedies proved ineffective, highlighting the importance of professional medical care in such situations.
Researchers have yet to fully determine whether the high acidity of the drink, its carbonation, or a combination of factors is what breaks down these formations.
Bezoars most commonly develop from excessive consumption of foods rich in cellulose and lignin, such as:
- persimmons
- pineapples
- celery
This case underscores the need for careful monitoring of patients taking medications that can affect gastrointestinal function. It also highlights the caution required when prescribing GLP-1 agonists, especially for individuals with coexisting conditions like diabetes. Healthcare professionals should be mindful of potential risks and complications during treatment to ensure a safe and effective recovery process.
As advancements in diabetes treatment continue to emerge, new research highlights the potential of an experimental diabetes medication that shows promise not only for weight management but also for blood sugar regulation. Understanding the implications of such treatments can provide valuable insights into effective strategies for managing conditions like obesity and diabetes.