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Phytobezoar

FieldValue
namePhytobezoar
fieldGastroenterology, general surgery

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. 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. 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. In addition to their presence in human stomachs, phytobezoars have been documented in the stomachs of slaughtered plant-eating animals.

Cause

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 of undigested lignin, cellulose, tannins, celery, pumpkin skin, grape skins, prunes, raisins, vegetables and fruits. Phytobezoars can form after eating persimmons and pineapples. These are more difficult to treat and are referred to as diospyrobezoars. Phytobezoars are more likely to form due to the ingestion of raw plant foods, even in persons without predisposing factors, as cooking softens them for easier digestion.

Treatment

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). A systematic review 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.

Physical and chemical properties

Generally, bezoars can be found in the stomach in less than 0.5% of patients having an esophagogastroduodenoscopy. Tannin 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.

References

References

  1. (1992). "Phytobezoar: An uncommon cause of small bowel obstruction". Annals of the Royal College of Surgeons of England.
  2. (1998). "Phytobezoar: A rare cause of intestinal obstruction". Digestive Surgery.
  3. (2008). "Huge gastric disopyrobezoar: A case report and review of literatures". World Journal of Gastroenterology.
  4. (2015). "Review of the diagnosis and management of gastrointestinal bezoars". World Journal of Gastrointestinal Endoscopy.
  5. (2014). "Lentil soup bezoar". BMJ Case Reports.
  6. (January 2013). "Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment". Alimentary Pharmacology & Therapeutics.
  7. (2004-01-01). "Foreign Bodies". Elsevier.
  8. DiMarino, Anthony. (2002). "Gastrointestinal disease : an endoscopic approach". Slack.
  9. (2013). "Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment". Alimentary Pharmacology & Therapeutics.
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This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

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