Clinical Characteristics and Treatment Outcomes of Nineteen Japanese Patients with Gastrointestinal Bezoars

Abstract

Objective To analyze the clinical characteristics of patients with gastrointestinal bezoars and their response to therapy. Patients We retrospectively reviewed the cases of 19 patients diagnosed with gastrointestinal bezoars at the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences or one of 15 collaborating institutions between December 2004 and August 2013. We investigated the epidemiology and etiology of the gastrointestinal bezoars by determining the gender, age at diagnosis, medical history, symptoms, complications, modalities used for diagnosis, treatments, outcomes and bezoar location, color and contents. Results There were 17 patients with gastric bezoars and two patients with small intestinal bezoars. All patients were 62 years of age or older, except for one case of a trichobezoar in a 10-year-old patient. Some of the patients had a history of surgery of any part of the gastrointestinal tract (n=5) and/or diabetes mellitus (n=2). The two patients with small intestinal bezoars required surgical removal in order to relieve ileus. Approximately one-half of the patients with gastric bezoars had ulcerations in the stomach (9/17 patients, 52.9%) and/or gastrointestinal bleeding (8/17, 47.1%). Endoscopic fragmentation was performed in 10 patients, whereas bezoar dissolution was achieved with a gastroprokinetic agent (n=1) and without any treatment (n=3) in the remaining cases. Conclusion As previously reported, elderly individuals with a positive history of surgery and/or diabetes mellitus were observed in this bezoar patient series. Gastric ulcers and gastrointestinal bleeding were frequently observed. The majority of patients underwent endoscopic fragmentation, while spontaneous resolution of the gastric bezoar was observed in several cases.

An Energy Dispersive X-ray Spectroscopy Analysis of Elemental Changes of a Persimmon Phytobezoar Dissolved in Coca-Cola

“…The immersion experiment revealed that Coca-Cola did not permeate the bezoar even after immersion for 120 hours. Our study results are consistent with those previously reported that indicated that Coca-Cola is ineffective for dissolving persimmon phytobezoars (6,8,(15)(16)(17). In our previous study, we investigated the ultrastructure of a persimmon bezoar by scanning electron microscopy and found that a high-density layer 20-to 50-μm thick constituted the exterior of the phytobezoar (18).…”

“…For instance, reports from Korea indicated that 3 L of cola lavage or drinking resulted in complete dissolution of non-persimmon phytobezoars in 66.7% (four of six) of cases, while it was not at all effective in patients with persimmon phytobezoars (0 of 11 cases) (8). Our previous case series also showed that persimmon phytobezoars were not dissolved by Coca-Cola beverages alone and they required endoscopic or surgical removal (6). Such clinical results indicate that persimmon phytobezoars are resistant to cola beverages due to their structural rigidity, which prevents permeation of liquid.…”

“…Since the first report in 2002 by Ladas et al (1), there have been many case reports and series describing the successful clinical outcome of bezoars treated with Coca-Cola or other carbonated drinks (2)(3)(4)(5)(6)(7)(8)(9)(10). In a report by Ladas et al, 24 articles including 46 patients were reviewed and the authors stated that treatment with CocaCola led to phytobezoar resolution in 91.3% of the cases, either as a sole treatment or in combination with an endoscopic procedure (11).…”

Bezoars: a rare cause of rapunzel syndrome and large bowel obstruction by sigmoid volvolus

“…For example, multiple cases of persimmon phytobezoar (diospyrobezoar) have been reported in regions where the residents frequently consume fresh persimmon fruits and dried persimmons. 10 Our results of higher prevalence of trichobezoars in young females with trichotillomania and trichophagia were resembling other previous reports which show that trichobezoars are nearly always gastric and diagnosed in young females. 11 The clinical presentation of bezoars in our study was not different from other studies, except for the case of sigmoid colon bezoar caused by a very rare type of foreign body bezoar that presented with sigmoid volvolus and acute abdomen.…”

“…While all the attempts failed in one study, it was successful in many others. 10,12,14 Laparoscopic removal of bezoars continues to be controversial. 12 The first described case of laparoscopic removal of a gastric trichobezoar was in 1998 and since then a few case reports described successful laparoscopic removal of gastric bezoars, generally in adults and adolescents.…”