Coca-Cola treatment of phytobezoars

Recommended for the treatment of phytobezoars

The presence of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. It consists of a solid and formed mass trapped in the gastrointestinal system, usually in the stomach.^[1][2][3] These can also form in other locations.^[4][5]

Gastric phytobezoars are a form of intestinal blockage and are seen in those with poor gastric motility. The preferred treatment of bezoars includes different therapies and/or fragmentation to avoid surgery. Phytobezoars, are most common and consist undigested, lignin, cellulose, and tannin, celery, pumpkins, grape skins, prunes, raisins, vegetables and fruits^[1] Phytobezoars can form after eating persimmons and pineapples. These are more difficult to treat and are referred to as diospyrobezoars.^[6]

Coca-Cola has been proposed for the treatment of gastric phytobezoars. In about 50% of cases studied, Coca-Cola alone was found to be effective in gastric phytobezoar dissolution. Unfortunately, this treatment can result in the potential of developing small bowel obstruction in a minority of cases, necessitating surgical intervention.^[1] It is one of many other stomach disorders that can have similar symptoms.^[7]

History and medical uses

Coca-Cola has a long history of medical uses. It was first used as substitute for morphine by Confederate Colonel John Pemberton. He had become addicted to morphine after being wounded in the Civil War and was intent on finding a substitute.^[8] The first Coca-Cola recipe was created at Pemberton's own Eagle Drug and Chemical House, in Columbus, Georgia and originally marketed as a coca wine.^[9][10][11]

In response to the passage of local prohibition laws passed in 1886, Pemberton then changed the composition and created a nonalcoholic version of his coca wine.^[12] This newly formulated version was sold in his store and marketed as a patent medicine for five cents^[13][14] per glass at his store's soda fountains, which were becoming more numerous at the time because of the belief that carbonated water was good for the health.^[15] Pemberton advertised that Coca-Cola cured many diseases, including morphine addiction, dyspepsia, neurasthenia, headache, and impotence. By 1888 production had increased along with medical claims. In April 1888, a druggist Asa Griggs Candler, purchased a one-third interest in the formula of the proprietary elixir known as Coca-Cola.^[16] A phytobezoar was first successfully treated with Coca-Cola lavage in 2002.^[1]

Treatment

The use of Coca-cola is often the primary treatment recommended to dissolve phytobezoars.^[17] Naso-gastric administration of Coca-Cola is used in pediatric patients to dissolve plant-based phytobezoars.^[18] Coca-cola can also be administered orally and during an endoscopy.^[19] Coca-Cola completely dissolves phytobezoars in about half of the cases. It promotes dissolution by endoscopic techniques in the majority of the patients left, leading to a final success rate up to 91.3%.^[6] In some cases, regular use of Coca-Cola resulted in no recurrence 3–15 months after the first episode.^[6] Treatment has varied widely. Coca-Cola has been administrated either as drinking beverage or as lavage. Some are treated with various combinations of drink, injection and irrigation. The volume of Coca-Cola in treatment varies along with daily dose and time of treatment. Dosages varied from 500 mL up to 3000 mL and treatment period 24 hours to 6 weeks. When lavage is used, a double-lumen nasogastric tube or two separate tubes using 3000 mL of Coca-Cola is administered during a 12-hour period.^[6] Alternative treatments are the use of cellulase, acetulcysteine, papain, pancreatic enzymes, saline solution, 0.1 N HCl and sodium bicarbonate. with papain such as gastric ulcer, hyponatremia and oesophageal perforation.

Contraindications

Trichobezoars do not respond to treatment with Coca-Cola but instead this type may have to be surgically removed.^[19] Persimmon diospyrobezoars sometimes are resistant to Coca-Cola and require a different treatment. This can include endoscopic fragmentation and/or surgical approaches especially in urgent cases where the patient exhibits gastrointestinal bleeding.^[1][6]

Adverse effects and interactions

Adverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation.^[6] These effects have not been observed with the use of Coca-Cola. Glucose levels during the administration of Coca-Cola have not been addressed.

Pharmacology and interactions

In addition to Coca-Cola, Adolph's Meat Tenderizer has been used to dissolve baozars of the stomach.^[20][21] When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%.^[22] The mechanism by which Coca-Cola dissolves the bezoar is based upon its low pH, CO² bubbles, and sodium bicarbonate content.^[19] It is not apparent whether the dissolving attributes of Coca-Cola apply to Coke Zero, Diet Coke or other flavored varieties.

"...patients given a continuous infusion of Coca-Cola by nasogastric tube over 12 hours showed complete resolution of bezoars. If you cannot find a can of Coke, perhaps Pepsi will do the trick, assuming it does not cause dysPEPSIa."^[20]

Some clinicians have described the mode of interaction is based upon the acidification of the gastric contents and the release of CO₂ that causes disintegration. Three and a half liters given nasogastrically over 12 hours has been found to dissolve these bezoars.^[23] Coca-Cola has a pH of 2.6. This is due to carbonic and phosphoric acid which resemble gastric acid. Gastric acid is believed to facilitate the digestion of fibers. In Coca-Cola, NaHCO₃ has a mucolytic effect and CO₂ bubbles enhance dissolving the bezoar. Coca-Cola reduces the size and softens the make-up of the bezoar, and combined with other treatments, enhances the dissolution.^[6]

Physical and chemical properties

Generally, bezoars can be found in the stomach in less than 0.5% of having a esophagogastroduodenoscopy.^[1] The formation of phytobaozars from persimmons is due to a chemical reaction between stomach acid and phlobatannin contained in the persimmon.^[3] Tanin and shibuol found in the skin of unripe persimmons, reacts with gastric acid and forms a coagulum. This structure then accumulates cellulose, hemicellulose and protein.^[6]

Manufacturing

Coca-Cola is the best-selling soft drink in most countries, and was recognized as the number one global brand in 2010.^[24]

Society and culture

With frequency, unusual cases of phytobaozars found in patients are reported in the news along with the information about treatment with Coca-Cola.^[25][26][27]

Recreational use

Coca-Cola's primary use is recreational and its medicinal use is of recent origin.^[1] It has been described as the 'first energy drink'.^[28]

Research

The protocol for the treatment of phytobezoars with Coca-Cola, i.e., dosage and timing has not been standardized and further investigation has been encouraged.^[1]

References