[Dysphagia] Pica

[eripley at yahoo.com (Irene Campbell-Taylor)]

It is necessary to distinguish between geophagia (eating dirt and clay) and swallowing objects. The former is often, as noted, due to iron and other mineral deficiencies. The latter is something else. I have had patients with the following found in the stomach and intestine: combs, stones, pins, rubber gloves, bottle caps, toothbrush, small toys, and on and one. One wonders how they got through the pylorus.
Also, mouthig to the point of biting hands, fingers, arms is often a sign of the pain of GER.
A couple of refs. re iron deficiency:

Giudicelli J; Combes JC .Pica and iron deficiency in adolescence . Arch Fr Pediatr 1992 Nov;49(9):779-83   

 BACKGROUND. Pica is a habit disorder involving the compulsive, irrational ingestion of nutrient or non-nutrient substances which usually, in young infants, include clay and earth. Pica is rare in adolescents but is more likely to occur in subjects with severe iron deficiency. POPULATION AND METHODS. 17 (16 girls, 1 boy) cases of pica were recognized over a period of 4 years in an adolescent unit. 15 of the cases presented with anemia and/or iron deficiency. Hematological and biochemical investigations included measurements of hemoglobin content, MCV, serum iron and ferritin, transferrin saturation and serum iron-binding capacity. Blood loss was considered as a possible cause in all patients. RESULTS. 13 of the patients ingested large amounts of raw rice and 11 ingested ice cubes; 10 patients ingested both substances. Their mean serum ferritin was 7.17 ng/ml and the mean hemoglobin was 8.7 g/dl. One out of 7 patients showed intestinal blood loss. Excessive menstrual bleeding occurred
 in 8 girls. All patients were treated with adequate amounts of iron. Pica disappeared within a few weeks, although biochemical evidence of iron deficiency persisted in some patients. In one case, pica persisted despite correction of the iron deficiency

 
McLoughlin IJ; Hassanyeh F Pica in a patient with anorexia nervosa. Br J Psychiatry 1990 Apr;156:568-70    A case of an unusual pica in a patient with anorexia nervosa is described. The patient was also found to have iron-deficiency anaemia. The relationship of mineral deficiency to pica and anorexia nervosa is discussed.


Dr I Campbell-Taylor
Clinical Neuroscientist
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