Competitive speed eating has emerged over the past decade as an increasingly popular competitive sport with a growing legion of worldwide fans. These contests raise a fascinating question about how speed eaters are able to consume such enormous quantities of food in such short periods of time. In a study by Levine et al. from 2007 [49], this issue was addressed in a speed eating simulation with fluoroscopic observation of a professional speed eater ranked as one of the top competitors in the world by the International Federation of Competitive Speed Eating (IFOCE). The speed eater was found to have markedly altered gastric motility at fluoroscopy, as his stomach rapidly accommodated an enormous quantity of ingested food by progressively expanding until it became a giant, flaccid sac occupying a major portion of his abdomen (Fig. 29.11). Put differently, his stomach acted as a compliant, expansile receptacle, dilating to a degree that it could accept an almost unlimited volume of food. Conversely, gastric peristalsis was virtually absent at fluoroscopy, and little or no ingested food emptied into the duodenum. Though the simulation involved only a single speed eater, the fluoroscopic findings were so spectacular that the investigators postulated that the profound gastroparesis observed in their subject could be extrapolated to speed eaters in general as the basis for their speed eating skills [49].

On subsequent questioning, the speed eater indicated that he developed his speed-eating skills by extensive training, forcing himself to consume ever-increasing amounts of food despite a sensation of satiety [49]. In effect, he was able to overcome the usual checks and balances associated with eating by exercising extreme self-discipline to consume larger and larger quantities of food than “normal” eaters could ever ingest. Only as a result of this prolonged and intensive training was the speed eater able to adapt his stomach until it could withstand the rigors of competitive speed eating. In that sense, a world-class speed eater requires a level of commitment and will power comparable to those of professional athletes honing their skills for other sports.

Nevertheless, the investigators who performed the simulation expressed concern that a chronically dilated, flaccid stomach with profound self-induced gastroparesis could eventually decompensate, becoming an enormous sac incapable of shrinking to its normal size and incapable of peristalsing and emptying solid food [49]. If so, long-term competitive speed eaters could develop intractable nausea and vomiting, potentially necessitating a partial or total gastrectomy to relieve their symptoms and restore their ability to eat normally [49]. In this context, competitive speed eating could be viewed as a self-destructive form of behavior, so competitive speed eaters need to be aware of the potential long-term risks of this sport.

When patients with recurrent nausea and vomiting have immediate retching and emesis of ingested barium on an upper GI barium study, some radiologists erroneously assume that there will not be an adequate volume of barium in the stomach to obtain a diagnostic examination. It turns out, however, that even a small amount of residual barium in the stomach often enables differentiation of gastric outlet obstruction or gastroparesis from extraintestinal causes of recurrent nausea and vomiting, such as narcotics, chemotherapy, acute infectious conditions, seizures, increased intracranial pressure, and vestibular disorders. Patients with gastric outlet obstruction or gastroparesis typically have a dilated stomach with intraluminal fluid and/or food that dilutes ingested barium and delays emptying of barium into the duodenum and proximal small bowel. In contrast, patients with extraintestinal causes of nausea and vomiting typically have a collapsed or partially collapsed stomach with rapid emptying of residual barium into collapsed or partially collapsed duodenum and proximal small bowel. In such patients, the combination of rapid emesis of ingested barium and a collapsed stomach with rapid emptying of residual barium from the stomach have led to the designation of a so-called “hyperirritable” stomach [2]. These findings therefore should prompt a careful search for extraintestinal causes of nausea and vomiting in affected individuals. The following section discusses in greater detail the predisposing factors as well as the clinical and radiographic findings in patients with a hyperirritable stomach.