The Case
A 63-year-old Massachusetts woman walked into the emergency room feeling awful. Nausea. Vomiting. No appetite.
She also had burning pain. High up in the abdomen, wrapping around the right side of her body to her back. Over-the-counter acid reflux meds didn’t touch it. Nothing worked for about a month.
Context matters. She had started semaglutide—a GLP-1 receptor agonister in the same class as Ozempic—the year before. She has type 2 diabetes. She is also obese. The drug worked, technically. She lost 40 pounds.
But lately, the weight loss got scary fast.
Doctors ordered a CT scan of her abdomen and pelvis. It showed her bile ducts were slightly dilated. Her stomach was stretched, full of “semisolid material.” Heavy stool burden too, but no blockage. Just stuff sitting there.
The Mass
To look closer, they used a specialized MRI technique called MRCP. It confirmed the dilated bile ducts and showed a mass in her stomach. It looked like trapped air.
They scoped her out. Endoscopy from esophagus to small intestine.
They found a gastric bezoar.
Imagine a tightly packed blob of undigested or partially digested matter. Solid. Dense. Sitting right there in the stomach.
The doctors stopped the semaglutim immediately. Makes sense. The drug slows gastric emptying. It tells your stomach to hold everything. The woman’s stomach had held onto a meal long enough to turn it into a rock.
The Soda Solution
Here is the strange part.
You do not use surgery first. You use soda.
Cola breaks down bezoars. It sounds like an urban legend but it is standard first-line treatment for stable patients. Cheaper. Less risk than sticking instruments up there and chopping it apart.
The standard prescription? Three liters. Within twelve hours.
They don’t even know why it works. Acidity? Carbonation? Who knows.
“Existing evidence… supports the administration of 3 liters of cola,” the doctors noted.
This patient had diabetes. So no sugary cola. Diet only. Plus she hated the bubbles. The team cut the dose in half. One point five liters.
Day two brought the change. A tugging sensation in the abdomen. Then relief. No more nausea. The scope came back again. The mass was gone. Dissolved.
She ate regular food. Discharged with no pain. She never went back on the GLP-1. Got a script for acid reflux pills instead. Weight crept back up a bit later, appetite returned. No recurrence in several months.
Why It Matters
Bezoars are rare. Less than half a percent of endoscopies show them. Their symptoms mimic a hundred other things. Pain. Vomiting. Discomfort. You usually guess the more common ailment first.
Most bezoars are phytobezoars. Made of plant fiber. Eat too many persimmons, raisins, celery, pineapples. Your stomach gets stuck.
But drugs change the game. Surgeries that alter stomach shape? Autonomic nerve damage? GLP-1s? They all delay emptying. Semaglutide essentially put this woman’s digestion in pause mode. When the pause ended, the damage was already done.
Soda fixed it. It remains a bizarre solution for a bizarre problem. But it worked.
