The stomachs of competitive eaters accommodate large quantities of food by repeated rapid distension of the gastric wall during eating episodes. A Clinical Challenges and Images in GI article in the June issue of Gastroenterology presents an adverse outcome of these competitions.
Tian-Zhi Lim et al describe the case of a 30-year-old, healthy man who arrived at the emergency department with abdominal pain and distension 8 hrs after a competitive speed eating event, at which he consumed a 3.2-kg burger (about 7 lbs) in 30 minutes. The patient had vomitus that was nonbloody and nonbilious, comprising undigested food materials.
Clinical examination revealed a tense and distended abdomen, but no pneumoperitoneum was noted on the initial chest radiograph (panel A). The patient had an increased white blood cell count and serum levels of creatinine (150 μmol/L) and amylase (501 U/L). He also had metabolic acidosis.
A computed tomography scan of the abdomen and pelvis showed that the stomach and proximal duodenum were grossly distended with food material (panel B), with an abrupt caliber change at the third part of the duodenum (panel C). The patient’s pancreas was compressed and the bowels were pushed to the left iliac fossa (panel D).
Lim et al performed gastric lavages through a nasogastric tube to decompress the distended stomach, but the patient’s symptoms persisted. Plans for an open gastrostomy to evacuate the undigested food particles were abandoned when the patient started to pass flatus, and there was resolution of metabolic acidosis and white blood cell counts. Eventually, the patient managed a bowel movement; he was discharged from the hospital 5 days later.
Lim et al explain that swallowing large amounts of unchewed food, as people do in competitions, results in accumulation of solid food particles in the stomach which cannot enter the duodenum. The mass effect from the distended stomach worsens the condition by compressing the duodenum. This resulted in the acute pancreatitis and acute kidney injury in this patient.
Gastric lavage within 24 hrs of the onset of symptoms can decompress the distended stomach sac, by breaking up the food into smaller pieces. However, if symptoms worsen or biochemical analyses indicate increasing acidosis, gastrostomy to evacuate food particles is required. Prolonged distention of the gastric wall can induce microischemia and increase the risk of perforation.
Extreme overeating can cause gastroparesis, aspiration pneumonia, GI bleeding, Mallory-Weiss tear, Boerhaave syndrome, and morbid obesity. Lim et al discourage these these competitions, stating that they test the limits of human health.