University of South Florida Morsani College of Medicine Tampa, FL
Chukwudumebi Uche, DO, Rafael Rivera Sepulveda, MD, Omar Calderon, MD University of South Florida Morsani College of Medicine, Tampa, FL
Introduction: Pica is defined as the craving and intentional ingestion of substances not culturally defined as food. Xylophagia is a form of pica that involves the consumption of paper. Our case illustrates a rare form of pica, xylophagia, of which few cases have been reported in the literature.
Case Description/Methods: A 65-year-old female with a history of gastric bypass presented with severe epigastric pain, nausea, and vomiting. Upon further history, the patient admitted to craving and consumption of 4 sheets of paper daily over the past 5 months due to concerns about food insecurity. Her physical exam was remarkable for significant epigastric tenderness. Laboratory findings were notable for hemoglobin 6.7 g/dL, MCV 62.7 fL, iron 16 mcg/dL, and total iron % saturation 3.5%. Physical exam with significant epigastric tenderness. CT abdomen/pelvis revealed severe wall thickening of the antrum of the excluded stomach post-Roux-en-Y, measuring up to 3.1 cm in single wall thickness with significant stool burden (Figure 1). She underwent colonoscopy and small bowel enteroscopy which were largely unremarkable. She was managed with IV iron replacement therapy and received 1 unit of packed red blood cells. Her abdominal pain resolved following management with an aggressive bowel regimen. Given negative endoscopic findings, the etiology of her iron deficiency anemia was suspected to be due to malabsorption in the setting of gastric bypass. She was discharged with close follow-up with psychiatry and gastroenterology.
Discussion: Xylophagia is a rare form of pica characterized by an unusual craving for the ingestion of paper. Pica is an eating disorder characterized by the persistent ingestion of nonnutritive nonfood substances for at least one month. Diagnosis is made based on clinical history. The incidence of pica has been linked strongly to iron deficiency, celiac disease, and comorbid conditions such as intellectual disability and schizophrenia. The etiology of pica remains unknown, although, several hypotheses have suggested a nutritional and psychosocial origin. Complications of pica include lead toxicity, constipation, intestinal obstruction caused by bezoar formation, and in some cases bowel perforation from the ingestion of sharp objects. Management involves treating the underlying cause of the craving and consultation with a psychologist. A multidisciplinary approach involving the physician, psychologist, and social worker is recommended for effective treatment, as was done in our patient.
Figure: Figure 1. CT Abdomen/Pelvis: 3.1 cm antrum wall thickening.
Chukwudumebi Uche indicated no relevant financial relationships.
Rafael Rivera Sepulveda indicated no relevant financial relationships.
Omar Calderon indicated no relevant financial relationships.
Chukwudumebi Uche, DO, Rafael Rivera Sepulveda, MD, Omar Calderon, MD. P1376 - Xylophagia: A Rare Case of Pica, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.