Gastric Bezoar Linked to Weight-Loss Medication: Diagnosis and Treatment Insights

A 63-year-old woman presented to the Brigham and Women’s Hospital emergency department in Boston with severe abdominal pain, nausea, and vomiting.

She reported that over the past month she had developed severe nausea, vomiting without blood, and pain she described as burning, radiating from the upper abdomen to the right and around to the back. None of these measures provided relief.

The clinicians gathered a detailed medical history: the patient has been diagnosed with severe obesity and comorbidities – type 2 diabetes, chronic kidney disease (stage 2), opioid use disorder, and gastroesophageal reflux disease (GERD), among others. She also reported that over the past year she had been taking semaglutide – a GLP-1–based weight-loss medication that led to a weight loss of about 40 pounds (more than 19% of her starting weight).

In a recent interactive case published in a medical journal, doctors explained how they determined the cause of the problem and how it was treated – with an unexpectedly simple solution.

Evaluation and Diagnosis

The patient was admitted after laboratory analyses and imaging. Abdominal computed tomography showed dilation of the bile ducts and a distended stomach filled with a mass with clearly delineated margins.

MRI likewise identified a mass in the stomach with a mosaic texture, which doctors interpreted as air bubbles. The imaging also revealed dilation of the bile ducts, which could be related to prior opioid use or to the presence of a gastric bezoar.

What is a Gastric Bezoar?

A bezoar is a collection of contents in the stomach. There are different types depending on the material from which they are formed. The most common is phytobezoar, which consists of clumped pieces of plant food and indigestible materials such as cellulose. A special subtype of phytobezoar is diospyobezoar, which can form after excessive consumption of persimmons. The fruit’s skin is rich in tannins, which in the gastric environment form a sticky substance that promotes the formation of a mass known for its hardness and difficulty of treatment.

Such formations can block the digestive tract and require different approaches to treatment depending on their size and composition. In this case, the associations between the use of GLP-1–based weight-loss medications and the risk of bezoar formation were discussed, requiring careful monitoring of patients.

Treatment and Outcome

The doctors approached treatment individually, taking into account the size and composition of the bezoar. As part of a conservative strategy, gastric lavage was performed and a dietary slurry was used, proposed as a solution for thinning and partial dissolution of the mass. After administration of this solution, the patient’s condition improved: nausea decreased, the pain became less pronounced, and there was partial thinning and movement of the mass further along the digestive tract.

Further evaluations confirmed a reduction in the volume of the mass, after which the patient was referred for ongoing follow-up and adjustment of the treatment plan considering her condition and tolerance of the prescribed medications. Measures to prevent recurrence of bezoars and monitoring of weight-loss regimens were also discussed.

Conclusion

Diagnosis and classification of gastric bezoars using modern imaging techniques allow for rapid diagnosis and planning of effective treatment. In this case, careful medical history taking and attentive consideration of the impact of weight-loss medications on bezoar formation played a key role. The treatment, which included the use of a dietary beverage to dissolve the mass, enabled the patient to relieve symptoms and avoid more invasive procedures. Ongoing monitoring and preventive measures are important to prevent recurrence of bezoars and to adjust lifestyle.