Background: Disordered eating behaviour including binge-eating often results in significant medical conditions, which are at times fatal. It can result in acute gastric dilatation which can lead to ischemic necrosis and stomach rupture. Dyspepsia and bloating are common symptoms following binge eating. Patients commonly use over-the-counter medications like sodium bicarbonate or home remedies for relief. However, in very rare, reported cases, sodium bicarbonate has been attributed to cause acute gastric dilatation and spontaneous gastric rupture instead.
Methods: We report two cases of spontaneous gastric rupture following consumption of sodium bicarbonate containing antacids after a large meal, and a review of the literature of similar cases.
Results: A total of 36 cases were identified. Approximately half of the cases (47.2%) were correlated with eating disorders, with higher prevalence in females (69%) and a very high mortality rate (41.6%). Amongst the 36 cases, sodium bicarbonate ingestion was associated with 10 cases. The lesser curvature (36.1%) and anterior wall (33.3%) are the most common sites of rupture. Associated causes include binge-eating, gas release from sodium bicarbonate, gastric content fermentation, proximal and distal outlet obstruction, and muscular atony.
Discussion: Sudden distension and impaired emptying mechanism of the stomach is necessary for spontaneous gastric rupture to occur. Acute gastric dilatation with perforation requires definitive surgical management. There should be a low threshold of suspicion for patients presenting with severe abdominal pain and abdominal distension following an episode of binge-eating. There is a need for patient education around the use of over-the-counter medications or home remedies.
Keywords: Feeding and eating disorders; Gastric dilatation; Sodium bicarbonate; Stomach rupture.
Disordered eating ranges from simple dieting to eating disorders. A large proportion of overweight or obese adolescents and young adults engage in disordered eating behaviours, most commonly binge-eating. While such behaviours can result in significant medical conditions, it commonly results in uncomfortable gastrointestinal symptoms. Over-the-counter medications are often used to relieve symptoms like indigestion, abdominal pain, and heartburn. Sodium bicarbonate, a common ingredient in these medications, has been associated with spontaneous stomach rupture. Despite this, sodium bicarbonate is suggested online as a home remedy for these symptoms. In this article we report two such cases of spontaneous stomach ruptures following the consumption of sodium bicarbonate containing antacids, following a large meal. We then review the literature for similar cases. We discuss the functional changes in the body resulting in the injury, the mortality rates, suggested management approaches and the relevance of our study. Our article emphasises the need for a low threshold of suspicion for patients presenting with severe abdominal pain with abdominal distension following a binge-eating episode. There is also a need to educate patients surrounding the use of over-the-counter medications or home remedies, as they are often unaware of potentially fatal adverse effects with inappropriate use.
© 2022. The Author(s).