Roberto C. Simons-LinaresRicardo MorgensternAbel Acosta-CanedoJaime Saravia-Burgos2026-03-222026-03-22201810.14309/00000434-201810001-00187https://doi.org/10.14309/00000434-201810001-00187https://andeanlibrary.org/handle/123456789/67344Introduction: Natives from the Andes of South America have used coca leaves (chew, tea, cuisine) for centuries to enhance physical performance. There is controversial evidence on the benefits, disadvantages and potential harm of using coca leaf. This topic has been for decades a subject of many political debates regarding coca leaf growing control policies. Sigmoid volvulus (SV) is one of the leading causes of lower intestinal obstruction in The Andes countries (Bolivia, Chile, Ecuador, Peru and Northern Argentina). Currently, it is the third most common cause of colonic obstruction in the United States after cancer and diverticulitis. We describe a unique cohort of patients and investigate predictors of outcomes with a special interest in coca-leaf chewers and/or Chagas-positive groups. To our knowledge this is the first study that addresses this problem. Methods: A prospective cohort study was conducted on patients admitted with SV at the Bolivian-Japanese Gastroenterology Institute, a university tertiary Hospital in Cochabamba, Bolivia between 2000 and 2006. All patients were diagnosed by imaging (xray, CT scan). Adjustment was done for BMI, age and gender. Patients with incomplete data were excluded. Multivariable logistic regression models were constructed using STATA software version 14. Results: A total of 441 patients were analyzed. Mean age 55.6 years (17-98), 295 were men (66%). A total of 217 (48%) were Coca-chewers, 137 (31%) were Chagas-positive, 394 (88%) had successful endoscopic decompression, 77 (17%) needed surgical intervention and 6 patients (1.4%) died. Coca-chewing was found to be an independent risk factor for higher inpatient mortality (aOR: 6.1, p<0.05; CI: 1.1-33), higher surgery-mortality (aOR: 14.8, p<0.05; CI: 1.5-157), hospital readmission (aOR: 2.5, p<0.05; CI: 1.1-5.6). Chagas-positive was an independent risk factor for surgical intervention (aOR: 1.5, p<0.01; CI: 1.1-2.0), abnormal endoscopy findings (aOR: 1.5, p<0.01; CI: 1.1-2.0), hospital readmission (aOR: 2.6, p<0.01; CI: 1.1-5.8). Alcohol abuse was a risk factor for post-surgical complications (aOR: 22.6, p<0.05; CI: 1.1-43). Conclusion: Coca-chewing is an independent modifiable risk factor for SV mortality, surgical intervention and hospital readmission. Coca-chewing may create a chronic ischemic state that affects the healthy bowel and may also have adaptogens, which are capable of influencing the switch from Glycolysis to Lipolysis leading steatosis (Casikar et al).187_A Figure 1. Baseline population characteristics187_B Figure 2. Overall cohort main outcomes.187_C Figure 3. Outcomes comparing Coca-chewers versus Non-coca chewers.enMedicineCocaLogistic regressionCohortProspective cohort studySurgeryInternal medicineTraditional medicineDemographyarticle