A woman experiencing intense abdominal pain, nausea, and frequent vomiting decided to visit the emergency room, suspecting stress might be the underlying cause of her discomfort.
However, her symptoms were actually the result of a gooey green mass that had developed in her stomach, partially due to her GLP-1 medication.
The 63-year-old patient sought medical attention at Brigham and Women’s Hospital in Boston. She explained to the doctors that she had been using semaglutide, a GLP-1 receptor agonist marketed as Ozempic and Wegovy, for approximately one year.
Over the previous month, she experienced increased episodes of vomiting and nausea coupled with severe pain near her torso. While the medication had initially helped her lose a significant amount of weight, the rate of weight loss had sped up in the last month, coinciding with these new symptoms.
The medical team conducted several diagnostic tests, including a CT scan that revealed a blockage of stool in her digestive tract, although there seemed to be nothing physically obstructing its passage. Using an endoscope—a slender, flexible tube equipped with a camera and light—the doctors finally identified the root of the problem.
The case of the bizarre bezoar
They saw a “large, greenish, gooey-looking mass covered in mucus” in her stomach. It was a bezoar, which affects at most 4 in 1,000 people. While it wasn’t blocking the opening to the small intestine, it was taking up a lot of space and making it harder for food to pass through.
Bezoars are tightly packed masses of undigested or partially digested food, usually in the stomach. There are a few different types. Phytobezoars form from eating too much cellulose-rich food, like celery, prunes, raisins and pumpkin. Trichobezoars form from hair.
In her case, doctors believe delayed gastric emptying caused the bezoar to form.
Gastric emptying is the process of food moving from the stomach into the small intestine. If it’s delayed — a condition called gastroparesis — food can accumulate and harden into a bezoar.
This slowing of food movement also happens to be one of the main effects of GLP-1s. It helps people feel fuller for longer, slows the rate at which carbs are broken down and prevents sugar from flooding the bloodstream.
But GLP-1s are known for sometimes slowing food down too much, causing gastroparesis. This side effect is associated with increasing dosage too quickly. Gastroparesis can lead to nausea, vomiting, bloating, pain, poor appetite and heartburn.
Around 11% of US adults are on a GLP-1, or roughly 28 million to 30 million people.
A Coca-Cola cure
The woman was taken off her GLP-1 immediately, but doctors now had a different problem on their hands: how to get rid of the bezoar.
There are a few options: break it up with an endoscopic knife or use medications like metoclopramide or erythromycin to chemically get things moving. If those don’t work, doctors might resort to surgically removing the bezoar.
But why use meds when a cold Coke will do the trick?
It sounds silly, but yes — doctors have found it’s a great first treatment to try for bezoars before turning to more aggressive methods.
They’re not exactly sure what it is about Coca-Cola that dissolves bezoars so effectively. It could be that the carbon dioxide bubbles penetrate the fibers in the mass, helping to break it apart. Or it might be Coca-Cola’s acidity, which is close to the pH of stomach acid.
Even better news: Diet Coke works just as well as the regular stuff, research shows. That’s especially helpful because many people who develop bezoars have diabetes and need to limit their sugar.
This was true in the Massachusetts woman’s case. She was given Diet Coke, and because she didn’t like carbonation, she drank just 1.5 liters — about half the recommended amount used to break up a bezoar.
On the second day, she reported a “tugging sensation” in her abdomen and felt a wave of relief from the nausea and stomach pain. Another endoscopy showed the bezoar was gone.
She returned to her normal diet and stayed off her GLP-1. With the nausea, vomiting and pain gone, her appetite returned and she regained weight.