Gastrointestinal toxicity due to bitter bottle gourd (Lagenaria siceraria)─a report of 15 cases

Abstract

Traditional medicine is widely practiced in tropical countries. Bottle gourd (Lagenaria siceraria) fruit juice is advocated as a part of complementary and alternative medicine. If the bottle gourd juice becomes bitter it is considered toxic. We report 15 patients, who developed toxicity due to drinking bitter bottle gourd juice. Patients presented with abdominal pain, vomiting, hematemesis, diarrhea and hypotension within 15 min to 6-h after ingestion of bottle gourd juice. Endoscopy showed esophagitis, gastric erosions, ulcers and duodenitis. Hypotension was treated with crystalloids and inotropic support. All patients recovered in 1-4 days. Endoscopically the lesions healed in 2 weeks. Bitter bottle gourd can cause gastrointestinal toxicity with hematemesis and hypotension. Supportive management is the treatment and all patients recover within 1 week.

Bottle Gourd ( Lagenaria Siceraria ) Toxicity: A “Bitter” Diagnostic Dilemma

“…However, there is lack of standardization in the preparation of such juices and sometimes, especially when the juice is bitter, such medications can become dangerous and life threatening. A handful of reports have been published regarding clinical presentation, endoscopic appearance and treatment of bottle gourd toxicity in humans [3][4][5][6]. We report a case of bottle gourd juice poisoning with shock and multi-organ system failure, and review the literature in general and discuss the differential diagnosis in particular.…”

“…It is the unripe fruit which is most commonly utilized, after it is cooked. The fruits are believed to have cardioprotective, diuretic and nutritive properties by practitioners of Ayurveda and alternate therapy [4,6]. As a defense mechanism against insects and herbivore animals, the plant produces Cucurbitacin, a pheromone.…”

“…Cucurbitacins, which impart the bitter taste, are tetracyclic triterpenoids, hydrophobic derivatives of triterpenes, of various types (B, D, G and H), increased in concentration within the fruits of plants grown under stressful conditions like dehydration, extreme temperatures, poor soil quality. Cucurbitacins have shown promising pharmacological properties in animals such as anti-tumorigenic effects (in-vivo, in-vitro), cytotoxic effects, and increased capillary permeability leading to hypotension and ascites and pleural effusions [3][4][5][6]. Cucurbitacins are lethal in small doses in mice (1.2 mg cucA/kg) and fruits containing more than 130 ppm will cause symptoms if consumed [3,4].…”

“…Cucurbitacins have shown promising pharmacological properties in animals such as anti-tumorigenic effects (in-vivo, in-vitro), cytotoxic effects, and increased capillary permeability leading to hypotension and ascites and pleural effusions [3][4][5][6]. Cucurbitacins are lethal in small doses in mice (1.2 mg cucA/kg) and fruits containing more than 130 ppm will cause symptoms if consumed [3,4]. About 50-300 ml of juice can cause symptoms and the larger the quantity of the juice /fruit ingested the more severe the symptoms [4][5][6].…”

“…Cucurbitacins are lethal in small doses in mice (1.2 mg cucA/kg) and fruits containing more than 130 ppm will cause symptoms if consumed [3,4]. About 50-300 ml of juice can cause symptoms and the larger the quantity of the juice /fruit ingested the more severe the symptoms [4][5][6].…”