Clin Endosc.  2017 Jan;50(1):87-90. 10.5946/ce.2016.081.

Acute Gastric Injury Caused by Undissolved Sodium Picosulfate/Magnesium Citrate Powder

• Ze EY
• Choi CH
• Kim JW

• KMID: 2383496
• DOI: http://doi.org/10.5946/ce.2016.081

Abstract

Sodium picosulfate/magnesium citrate (SPMC) is a widely used oral bowel cleansing agent considered to be relatively safe. However, partially dissolved or undissolved SPMC powder may cause severe injuries of the esophagus and stomach. We report a very rare case of acute gastric injury without esophageal damage caused by the ingestion of undissolved SPMC powder. A 69-year-old man experienced epigastric pain after swallowing SPMC powder without dissolving it in water in preparation for a screening colonoscopy. He realized his mistake immediately and subsequently drank 2 L of water. The esophagogastroduodenoscopy conducted after 12 hours indicated an acute gastric ulceration without injury of the esophagus or duodenum. The endoscopy conducted after 6 weeks of oral proton pump inhibitor treatment showed healing of the gastric injury. This suggested that drinking large amounts of water after ingesting partially dissolved or undissolved SPMC powder can prevent serious esophageal injury, but offers no preventive benefit for acute gastric injury.

Keyword

Picosulfate sodium; Magnesium citrate; Cathartics; Adverse effects; Stomach ulcer

MeSH Terms

Aged
Cathartics
Citric Acid*
Colonoscopy
Deglutition
Detergents
Drinking
Duodenum
Eating
Endoscopy
Endoscopy, Digestive System
Esophagus
Humans
Mass Screening
Proton Pumps
Sodium*
Stomach
Stomach Ulcer
Water
Cathartics
Citric Acid
Detergents
Proton Pumps
Sodium
Water

Figure

• 

  Fig. 1. Upper gastrointestinal endoscopy performed 12 hours after ingestion of undissolved SPMC powder showing multiple longitudinal ulcers with hematin on the entire gastric body and antrum (B-E). (A) The esophagus and (F) duodenum present no mucosal abnormality.

• 

  Fig. 2. Histologic examination showing infiltration of lymphoid cells and neutrophils intermingled with fresh hemorrhage in lamina propria (A) H&E stain, ×40; (B) H&E stain, ×100.

• 

  Fig. 3. (A-D) Follow-up endoscopic findings 6 weeks after the event showing ulcer scar (arrows) on the gastric body in a healing state as compared with earlier findings.

Reference

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