Download Pica habit amylophagia

E-ISSN :0975-8437
P-ISSN: 2231-2285
CASE REPORT
Pica habit amylophagia - a case report
Lakshmi Rasaratnam
ABSTRACT
Pica is the persistent craving and compulsive eating of non-food substances. The stigmatism associated with eating
non-food products often leaves people feeling embarrassed to admit to their unusual eating habits, hindering appropriate medical diagnosis and management. This paper reports the unusual presentation of a 31 year old Afro-Caribbean
woman with a habit of eating starch corn flour.
Key words: Amylophagia; Dental; Pica
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
|
2014 Volume 6 Issue 1
Introduction
Pica is the persistent craving and compulsive eating of nonfood substances.1 The phenomenon of Pica has been reported
in medical journals for centuries and was first described to affect a pregnant woman in the 6th Century AD.2 The term originates from the Latin word for magpie, as this omnivore bird is
known to eat anything. Pica affects both men and women of
all ages and ethnicities. A higher incidence is associated with
developmental delays, psychiatric disorders, autism, pregnancy, low socio-economic status, poor nutrition/ nutritional deficiencies and certain religious/spiritual traditions. Worldwide,
20% of pica cases involve pregnant women, 25-33% small
children and 10-15% of cases involve those with learning disabilities.3 The three main types of Pica include the consumption of earth, soil or clay (Geophagia); the consumption of ice
(Pagophagia) and the consumption of starch (Amylophagia).
The high calorie content of starch consumption can cause excessive weight gain, however surprisingly; these patients are
malnourished due to the lack of vitamins and minerals within
the starch. Other types of pica habits include ingesting hair,
paint and paper.
Patients with pica are often iron deficient, however it is unclear
whether the iron deficiency causes the pica habit or if it occurs
as a result of it.4 The ingestion of substances such as clay is
known to block the absorption of iron into the bloodstream,
hence it is suggested that this could result in iron deficient
anaemia. However several studies have shown that pica habits
cease once patients are given iron supplements to correct the
iron deficiency. Patients with pica are at risk of medical complications such as metabolic disorders, lead/mercury poisoning,
parasitic infections, tooth wear and intestinal obstructions.4-6
Although the exact pathogenesis is unclear, there is a significant association with iron deficient anaemia.2,3,7 This paper
reports the unusual presentation of a 31 year old Afro-Caribbean woman with a habit of eating starch corn flour.
Case Report
A 31 year old Afro-Caribbean woman was referred by her general dental practitioner to the Dental Hospital for the surgical
removal of her impacted lower wisdom teeth. On presentation, the patient was slender in build, revealed no systemic
illness or allergies and her only medication included the oral
contraceptive pill. Clinically, her oral hygiene was good with
no evidence of tooth wear or parafunctional behaviour. Both
14
lower third molars were impacted with food trapping, bleeding on probing and 4-5mm pockets. The upper third molars
were over-erupted. The incidental finding of a concentric,
mixed radiolucent and radiopaque lesion was observed on
the Dental Panoramic Tomography (DPT) radiograph (Figure
1). A subsequent Cone beam Computer Tomography (CBCT)
scan gave a provisional diagnosis of fibro cemento osseus dysplasia. A clinical decision was made to extract all four wisdom
teeth and carry out a biopsy of the left mandibular lesion under general anaesthesia.
Prior to hospital admission for a general anaesthetic procedure, routine blood tests were carried out on the patient to
screen for possible sickle cell anaemia or any other conditions
ans several abnormalities were detected (Table 1). Iron deficiency was the most likely cause for the abnormal blood test
results, but a detailed history of possible bleeding sources
revealed no causes. The patient was questioned about menorrhagia (heavy periods), history of peptic ulcers, coeliac’s
disease, pregnancy, medications associated with GI bleeding
such as non-steroidal anti-inflammatory drugs or anticoagulants (aspirin, clopidogrel, warfarin), but there was no positive
correlation. Other possible causes such as malignancy were
also considered, investigated and ruled out. After extensive
investigations all revealed negative results, the patient finally
disclosed about her pica habit. She explained that she consumed 300grams of corn flour daily, a habit she had acquired
as a teenager. Under the advice of the Haematology specialists, the patient was prescribed a six-week course of ferrous
sulphate before proceeding with dental treatment.
Lab test
Value
Normal range
Haemoglobin
7.0
11.5-16.5 g/dl (women)
13-18 g/dl (men)
Mean Corpuscular
volume (MCV)
69.7fL
77-95 fL
Mean Corpuscular
Haemoglobin Concentration (MCHC)
21.0
32-36 g/dl
Ferritin
3mcg/L
18-160 mcg/L (women)
18-270 mcg/L (men)
Table 1: Routine pre-operative blood test results:
E-ISSN :0975-8437
P-ISSN: 2231-2285
Pica habit: Amylophagia –A case report
References
1. Von Garnier C, Stunitz H, Decker M, Battegay E, Zeller A. Pica
and refractory iron deficiency anaemia: a case report. Journal of
Medical Case Reports. 2008;2(1):324.
2. Coltman CA. Pagophagia and iron lack. JAMA. 1969;207(3):513-6.
3. Barker D. Tooth wear as a result of pica. British dental journal.
2005;199(5):271-3.
Figure 1. Dental Panoramic Tomograph
Discussion
6. Khan Y, Tisman G. Pica in iron deficiency: a case series. Journal of
medical case reports. 2010;4(1):86.
7. Kettaneh A, Eclache V, Fain O, Sontag C, Uzan M, Carbillon L, et al.
Pica and food craving in patients with iron-deficiency anemia: a
case-control study in France. The American journal of medicine.
2005;118(2):185-8.
8. Keith LG, Rosenberg CD, Brown E. Pica, pagophagia, and anemia.
Jama. 1969;208(3):535.
9. Ellis CR, Schnoes C, Giardino A, Windle Ml RD, Pataki C. Eating disorder: pica. Medscape [serial online] [Internet]. 2009. Available
from: http://iranianpda.net/medscape/A914765-business.html.
10. Thyer BA, Wodarski JS. Social work in mental health: an evidence-based approach: John Wiley & Sons; 2007.
How cite this article
Rasaratnam L. Pica habit: amylophagia –A case report. International
Journal of Dental Clinics. 2014;6(1):14-15.
Address for correspondence
Dr. Lakshmi Rasaratnam,
Senior House Officer, Oral & Maxillofacial Surgery,
The Royal London Hospital,
Barts Health NHS Trust,
New Road, Whitechapel, London E1 1BB.
Email: [email protected]
2014 Volume 6 Issue 1
Conclusion
In conclusion, the importance of taking thorough and accurate histories cannot be underestimated in order to provide
high quality dental care in a safe manner.
Authors Affiliation
1. Lakshmi Rasaratnam BDS (The London Schoolof Medicine
and Dentistry), Senior House officer in Oral Maxillofacial Surgery, The Royal London Hospital, Barts Health NHS Trust, New
Road, Whitechapel, London, UK.
|
Management of pica varies based on the aetiology. Children
tend to outgrow their habit whereas those with psychological components need referral to counsellors and therapists.
Co-ordinated team care between medical, dental and social
care professionals working together with patients and families is imperative.10 This case was managed with patient education, a course of iron supplements to treat the iron deficiency
and referral for psychological counselling. The patient’s fears
of being alone in her condition were allayed by making her
aware of the prevalence of the condition amongst many other people. All dentists are taught about the phenomenon of
pica during their undergraduate training however we rarely
attribute oral conditions such as tooth surface loss, recurrent
fractured restorations or abnormal findings on blood tests to
the possibility of this condition.
5. Gulia J, Yadav S, Rattan K, Hooda A. Complications Of Pica: Case
Report And Review Of Literature. The Internet Journal of Head
and Neck Surgery. 2007;2(2).
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Despite the fact that pica has been observed for centuries the
condition still remains elusive and fascinating in aetiology and
presentation. There is a strong association with iron deficient
anaemia, with several cases reporting that the pica disorder
resolves once the anaemia is addressed and treated.2,7-9 In this
case, the patient was malnourished due to the high intake of
starch corn flour, causing her iron deficient anaemia. Patients
with a pica habit are secretive about the condition and tend to
avoid mentioning it to medical professionals. Thus, pica related
symptoms go untreated for long periods without treatment.
Early diagnosis of the condition can help to prevent/minimise
bleeding problems or other medical complications, particularly during pregnancy. Certain population groups have a higher
prevalence of the pica habit; including those with nutritional deficiencies, developmental delays and during pregnancy.
Stress associated with traumatic events is also linked to pica.
For example, child abuse, maternal deprivation and parental
separation have been shown to be triggers for pica habits.
4. Swamy N, Dewang D. Pica disorder (Geophagia): a case report.
International Journal of Dental Clinics. 2011;3(4).
Source of Support: Nil
Conflict of Interest: None Declared
15