Jumperphagia: a woolly diagnosis

Last year in the JRSM, Woywodt and Kiss recorded the history of earth-eating,1 and Grewal and Fitzgerald2 described the case of a learning-disabled man who consumed metal objects and pieces of clothing. Some workers hypothesize that such habits (pica) are related to dietary deficiencies. Here we report some evidence in support. A woman of 67 was being investigated for longstanding iron deficiency. Upper gastrointestinal endoscopy had been negative, but on colonoscopy the bowel contained several clumps of what appeared to be fabric. A dietary history, taken thereafter, revealed that she was in the habit of consuming whole woollen jumpers at a single sitting; also her iron intake was low. After iron supplementation and nutritional advice, both her urge to eat wool and the anaemia gradually resolved. Pica has been linked with severe iron-deficiency anaemia in children3 and adults.4 The question of cause and effect has not been resolved. In the past the habit has been seen as a manifestation of other disorders rather than an entity.5,6 Here, cessation of pica after successful treatment of the anaemia indicates that iron deficiency might have contributed to the causation.