Bezoar

Bezoar stones were seen as valuable commodities, sometimes with magical healing properties, as in the old English case Chandelor v Lopus^[1]

A bezoar ( /ˈbiːzɔər/) is a mass found trapped in the gastrointestinal system (usually the stomach),^[2] though it can occur in other locations.^[3][4] A pseudobezoar is an indigestible object introduced intentionally into the digestive system.^[5]

There are several varieties of bezoar, some of which have inorganic constituents and others organic.

History

Bezoars were sought because they were believed to have the power of a universal antidote against any poison. It was believed that a drinking glass which contained a bezoar would neutralize any poison poured into it. The word "bezoar" comes from the Persian pâdzahr (پادزهر), which literally means "protection from poison."

In 1575, the surgeon Ambroise Paré described an experiment to test the properties of the Bezoar Stone. At the time, the Bezoar stone was deemed to be able to cure the effects of any poison, but Paré believed this was impossible. It happened that a cook at Paré's court was caught stealing fine silver cutlery. In his shame, the cook agreed to be poisoned. He then used the Bezoar stone to no great avail as he died in agony seven hours later.^[6] Paré had proved that the Bezoar stone could not cure all poisons as was commonly believed at the time.

A famous case in the common law of England (Chandelor v Lopus, 79 Eng Rep. 3, Cro. Jac. 4, Eng. Ct. Exch. 1603) announced the rule of caveat emptor, "let the buyer beware" if the goods he purchased are in fact genuine and effective. The case concerned a purchaser who sued for the return of the purchase price of an allegedly fraudulent bezoar. (How the plaintiff discovered that the bezoar did not work is not discussed in the report.) Judicial scepticism over the alleged magical powers of bezoars may well have justified this judgment in this particular case. The ruling, however, was seized on and formed an impediment to the formation of effective consumer protection remedies and the law of implied warranty well into the nineteenth century.

The Merck Manual of Diagnosis and Therapy notes that consumption of unripened persimmons has been identified as causing epidemics of intestinal bezoars, and that up to ninety percent of food boluses that occur from eating too much of the fruit require surgery for removal.^[7]

Types by content

• Food boli (singular, bolus) imitate true bezoars and are composed of loose aggregates of food items such as seeds, fruit pith, or pits as well as other types of items such as shellac, bubble gum, soil, and concretions of some medications.
• Pharmacobezoars (or medication bezoars) are mostly tablets or semi-liquid masses of drugs. Normally found following overdose of sustained release medications.^[8]
• Phytobezoars are composed of nondigestible plant material (e.g., cellulose) and are frequently reported in patients with impaired digestion and decreased gastric motility.
• Diospyrobezoar is a bezoar formed from unripe persimmons.^[9] Coca-Cola has been used in the treatment.^[10][11]
• Trichobezoar is a bezoar formed from hair ^[12]- an extreme form of hairball. Humans who frequently consume hair sometimes require these to be removed. The Rapunzel syndrome, a very rare and extreme case, may require surgery.

Types by location

• A bezoar in the esophagus is common in young children and in horses. In horses, it is known as choke.
• A bezoar in the large intestine is known as a fecalith.
• A trichobezoar in the trachea is called a tracheobezoar.

Miscellaneous

• There have been reports of esophageal bezoars in the nasogastrically fed patients on mechanical ventilation and sedation. These are implicated due to precipitation of certain feed types rich in casein which get precipitated with gastric acid reflux and form Esophageal bezoars.
• Other types of bezoars are formed from items such as stone or sand, usually in young children.
• Ox bezoars are used in Chinese herbology, where they are called niu-huang (牛黃) or calculus bovis^[13]. In some products, they claim to remove toxins from the body.
• In alchemy, animal bezoar is the heart and lungs of the viper, pulverized together.^[14]
• In alchemy, mineral bezoar is an emetic powder of antimony, correct with spirit of nitre, and softened by repeated lotions, which were said to carry off the purgative virtue of the antimony, and substitute a diaphoretic one. It promoted sweat like the stone of the same name.^[14]

See also

• Bezoardicum
• Enterolith
• Regurgitalith
• Snake-stones
• List of English words of Persian origin

Notes

References

• Barry Levine. 1999. Principles of Forensic Toxicology. Amer. Assoc. for Clinical Chemistry. ISBN ISBN 1-890883-87-5.
• Martín-Gil FJ, Blanco-Ávarez JI, Barrio-Arredondo MT, Ramos-Sanchez MC, Martin-Gil J. Jejunal bezoar caused by a piece of apple peel - Presse Med, 1995 Feb 11;24(6):326.
• The Poison Sleuths: Arsenic - The King of Poisons. Retrieved March 10, 2007. (This webpage is a reprint by the author of an article originally published in the 1997 issue of Science Reporter, published by the National Institute of Science Communication (CSIR) in India.)
•  This article incorporates content from the 1728 Cyclopaedia, a publication in the public domain.

External links

• A trichobezoar at the National Museum of Health and Medicine, Washington DC.
• Bezoars, Phytobezoars and Diospyrobezoars
• A trichobezoar from MedPix
• CT images of bezoar from MyPACS.net