Protein Shakes: An Unusual Cause of Gastric Phytobezoar

A 35-year-old healthy man presented with gradually progressive abdominal pain and distention, nausea, vomiting, early satiety, and 4.5-kg weight gain over 3-4 months. His routine blood work, thyroid panel, ultrasound, and abdominal/pelvic CT were unremarkable. Esophagogastroduodenoscopy (EGD) revealed a large gastric phytobezoar extending from gastric fundus to antrum (Figure 1). The patient disclosed his passion for exercising, including an intense gym regimen and a high intake of protein shakes (3-4 per day) over the previous 6 months. While he expressed interest in surgical removal of the bezoar, he was counseled to try conservative measures. He was started on papain, 1–2 tsp in 250 mL water by mouth 3 times per day, pineapple juice/cola to assist in dissolving bezoar, and metoclopramide to assist with gastric emptying. Repeat EGD 1 month later revealed significant decrease in the size of gastric phytobezoar, allowing endoscopic removal of the residual small phytobezoar (Figure 2). His symptoms resolved, and he now avoids overuse of protein shakes.