Glucomannan and risk of oesophageal obstruction.

Abstract

When all results were considered together the urine tube immunoassay (Model) gave 100% sensitivity and specificity as well as 100% predictive values for normal and abnormal results. The serum tube enzyme linked immunosorbent assay, while showing 100% sensitivity, was less specific, and the dipsticks were intermediate in value. CommentOur results are sufficiently encouraging to suggest that measurement of urinary hCG with ultrasensitive tube or dipstick assays should be the first line investigation in women presenting with non-specific abdominal complaints. Results equivalent to those of qualitative rapid radioimmunoassays may be obtained and appropriate further investigations such as laparoscopy, ultrasonography, and culdocentesis instituted. Qualitative tests do not differentiate ectopic from intrauterine pregnancy but offer a rapid and convenient assessment of secretion of hCG. The current assays may be simplified, and preliminary results using a two minute test (Icon, Hybritech) have been as good as those obtained with the assays described here (paper submitted for publication). These relatively simple, convenient, and commercially available enzyme labelled assays should be widely available in outpatient departments and wards for 24 hour use.I Seppala M, Kanta T, Tontti K, Stenman U-H, Chard T. Use of a rapid hCG-beta subunit radioimmunoassay in acute gynaecological emergencies.

Esophageal obstruction from a hygroscopic pharmacobezoar containing glucomannan

“…Henry et. al., who described this case series, studied five different glucomannan containing tablets in vitro and found varying rates and volumes of expansion for the various products (2). Volume changes ranged from 12.5 to 17.5 times the original volume with one product reaching an 8-fold volume increase in just two minutes (2).…”

“…The most well known hygroscopic medications implicated in esophageal obstruction are guar gum, psyllium, and glucomannan (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12). Their hygroscopic properties, the ability to swell rapidly when exposed to water, have made them an ideal agent for weight loss products.…”

“…Both substances have been used to control diabetes, help with weight loss, and reduce cholesterol (3). Both substances have also been implicated as the causative agent in cases of esophageal and intestinal obstruction, in patients taking tablets containing them (1,2,(4)(5)(6)(7)(8). In May 1985, marketing of tablets containing glucomannan was prohibited under the consumer product safety provisions of the Trade Practices Act in the country of Australia.…”

“…In May 1985, marketing of tablets containing glucomannan was prohibited under the consumer product safety provisions of the Trade Practices Act in the country of Australia. At the time of publication of this reference, powdered and encapsulated forms were still available (2). Other countries have limited the type of glucomannan preparations that can be marketed and sold because of their tendency to form obstructive pharmacobezoars.…”

“…On contact with water, the dry formulation begins to swell and becomes a very viscous gel. When used in a pill form, the volume and rate of expansion are affected by the presence or absence of encapsulating material, and other hygroscopic materials (2). Glucomannan, like guar gum, has been used for many years as a dietary fiber supplement.…”