Phytobezoar

A phytobezoar is a type of bezoar, or trapped mass in the gastrointestinal system, that consists of components of indigestible plant material, such as fibres, skins and seeds. While phytobezoars may be discovered incidentally on barium x-ray or endoscopic testing of the stomach, individuals with phytobezoars may develop symptoms: nausea, vomiting, gastric outlet obstruction, perforation, abdominal pain, and bleeding have been reported.[1] Conditions that lead to decreased motility in the stomach (gastroparesis) and surgeries on the stomach (such as vagotomy or gastric bypass) are associated with the development of phytobezoars.[2] A specific type of phytobezoar, termed a diospyrobezoar, is associated with ingestion of unripe persimmons, which contain a soluble tannin called shibuol that polymerizes into a coagulative cellulose-protein compound in the acid environment of the stomach, to form the bezoar.[3] In addition to their presence in human stomachs, phytobezoars have been documented in the stomachs of slaughtered plant-eating animals.[1]

Several treatments for phytobezoars have been described. Endoscopy involves using a fibre-optic flexible camera to identify the phytobezoar, that can be evacuated from the stomach using various assisted devices (such as Roth baskets, snares, or Dormia baskets).[1][3] If the phytobezoar cannot be removed due to size, electrohydraulic lithotripsy, mechanical lithotripsy, snares, or Nd:YAG laser therapy may be used to fragment the mass.[3] Papain (meat tenderizer) and cellulase enzymes have been used to help reduce the size of phytobezoars.[3] Coca-Cola ingestion has been found to be particularly useful to decrease the size of diospyrobezoars.[3][4] A systematic review of publications regarding initial treatment of phytobezoars with Coca-Cola found that Coca-Cola alone completely dissolved phytobezoars in half of cases, and that Coca-Cola combined with other endoscopic methods (particularly endoscopic fragmentation) was successful more than 90% of the time.[4] The same review found that diopyrobezoars (which are considered more difficult to dissolve because of their hard consistency) were successfully treated with Coca-Cola alone in only 23% of cases, but that followup endoscopic fragmentation was successful in 84.6% of cases in the publications reviewed.[4] When all other measures have failed, surgical gastrotomy is required to evacuate the bezoar.

References

  1. 1 2 3 Chisholm, E. M.; Leong, H. T.; Chung, S. C.; Li, A. K. (1992). "Phytobezoar: An uncommon cause of small bowel obstruction". Annals of the Royal College of Surgeons of England 74 (5): 342–344. PMC 2497638. PMID 1416706.
  2. ↑ Rubin, M.; Shimonov, M.; Grief, F.; Rotestein, Z.; Lelcuk, S. (1998). "Phytobezoar: A rare cause of intestinal obstruction". Digestive surgery 15 (1): 52–54. doi:10.1159/000018586. PMID 9845563.
  3. 1 2 3 4 5 Zhang, R. L.; Yang, Z. L.; Fan, B. G. (2008). "Huge gastric disopyrobezoar: A case report and review of literatures". World journal of gastroenterology : WJG 14 (1): 152–154. doi:10.3748/wjg.14.152. PMC 2673384. PMID 18176981.
  4. 1 2 3 Ladas, S. D.; Kamberoglou, D.; Karamanolis, G.; Vlachogiannakos, J.; Zouboulis-Vafiadis, I. (January 2013). "Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment". Alimentary Pharmacology & Therapeutics 37 (2): 169–173. doi:10.1111/apt.12141. PMID 23252775.
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