Protein Shakes: An Unusual Cause of Gastric Phytobezoar

TL;DRAbstract

Case Report 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

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