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Gastric bezoars

INTRODUCTION

Gastric bezoars are rare, cause nonspecific symptoms, and are usually found incidentally in patients undergoing upper gastrointestinal endoscopy or imaging [1]. This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of gastric bezoars.

DEFINITIONS

A gastric bezoar is defined as a foreign body resulting from accumulation of ingested material, most commonly found as a hard mass or concretion in the stomach.

Bezoars are classified according to their composition (table 1) [2-11].

Phytobezoars – Phytobezoars composed of vegetable matter, are the most common type of bezoar. The diospyrobezoar, composed of persimmon fruit, accounts for the majority of cases.

Trichobezoars – Trichobezoars are composed of hair.

                 

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Literature review current through: Sep 2014. | This topic last updated: Nov 11, 2013.
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References
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  1. Kadian RS, Rose JF, Mann NS. Gastric bezoars--spontaneous resolution. Am J Gastroenterol 1978; 70:79.
  2. Prisant LM, Carr AA, Bottini PB, Kaesemeyer WH. Nifedipine GITS (gastrointestinal therapeutic system) bezoar. Arch Intern Med 1991; 151:1868.
  3. Bernstein G, Jehle D, Bernaski E, Braen GR. Failure of gastric emptying and charcoal administration in fatal sustained-release theophylline overdose: pharmacobezoar formation. Ann Emerg Med 1992; 21:1388.
  4. Bogacz K, Caldron P. Enteric-coated aspirin bezoar: elevation of serum salicylate level by barium study. Case report and review of medical management. Am J Med 1987; 83:783.
  5. Reddy AN. Sucralfate gastric bezoar. Am J Gastroenterol 1986; 81:149.
  6. Kaneko H, Tomomasa T, Kubota Y, et al. Pharmacobezoar complicating treatment with sodium alginate. J Gastroenterol 2004; 39:69.
  7. Evans JR, Mitchell RD. Tissue paper bezoar associated with percutaneously placed gastrostomy tube. Gastrointest Endosc 1988; 34:142.
  8. Perttala Y, Peltokallio P, Leiviskä T, Sipponen J. Yeast bezoar formation following gastric surgery. Am J Roentgenol Radium Ther Nucl Med 1975; 125:365.
  9. Visvanathan R. Cement bezoars of the stomach. Br J Surg 1986; 73:381.
  10. Kamal I, Thompson J, Paquette DM. The hazards of vinyl glove ingestion in the mentally retarded patient with pica: new implications for surgical management. Can J Surg 1999; 42:201.
  11. Heinz-Erian P, Gassner I, Klein-Franke A, et al. Gastric lactobezoar - a rare disorder? Orphanet J Rare Dis 2012; 7:3.
  12. Lee J. Bezoars and foreign bodies of the stomach. Gastrointest Endosc Clin N Am 1996; 6:605.
  13. Krausz MM, Moriel EZ, Ayalon A, et al. Surgical aspects of gastrointestinal persimmon phytobezoar treatment. Am J Surg 1986; 152:526.
  14. Matsumoto K, Kadowaki A, Ozaki N, et al. Bile acid-binding ability of kaki-tannin from young fruits of persimmon (Diospyros kaki) in vitro and in vivo. Phytother Res 2011; 25:624.
  15. DeBakey M, Oshner A. Bezoars and concretions. Surgery 1938; 4:934.
  16. Balik E, Ulman I, Taneli C, Demircan M. The Rapunzel syndrome: a case report and review of the literature. Eur J Pediatr Surg 1993; 3:171.
  17. Pul N, Pul M. The Rapunzel syndrome (trichobezoar) causing gastric perforation in a child: a case report. Eur J Pediatr 1996; 155:18.
  18. Singla SL, Rattan KN, Kaushik N, Pandit SK. Rapunzel syndrome--a case report. Am J Gastroenterol 1999; 94:1970.
  19. Fallon SC, Slater BJ, Larimer EL, et al. The surgical management of Rapunzel syndrome: a case series and literature review. J Pediatr Surg 2013; 48:830.
  20. Robles R, Parrilla P, Escamilla C, et al. Gastrointestinal bezoars. Br J Surg 1994; 81:1000.
  21. White NB, Gibbs KE, Goodwin A, Teixeira J. Gastric bezoar complicating laparoscopic adjustable gastric banding, and review of literature. Obes Surg 2003; 13:948.
  22. Calabuig R, Navarro S, Carrió I, et al. Gastric emptying and bezoars. Am J Surg 1989; 157:287.
  23. Hewitt AN, Levine MS, Rubesin SE, Laufer I. Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol 2009; 82:901.
  24. Stack PE, Thomas E. Pharmacobezoar: an evolving new entity. Dig Dis 1995; 13:356.
  25. McCracken S, Jongeward R, Silver TM, Jafri SZ. Gastric trichobezoar: sonographic findings. Radiology 1986; 161:123.
  26. Newman B, Girdany BR. Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol 1990; 20:526.
  27. Chintapalli KN. Gastric bezoar causing intramural pneumatosis. J Clin Gastroenterol 1994; 18:264.
  28. Valberg LS, McCorriston JR, Partington MW. Bezoar: an unusual cause of protein-losing gastroenteropathy. Can Med Assoc J 1966; 94:388.
  29. Nomura H, Kitamura T, Takahashi Y, Mai M. Small-bowel obstruction during enzymatic treatment of gastric bezoar. Endoscopy 1997; 29:424.
  30. Chen HW, Chu HC. Migration of gastric bezoars leading to secondary ileus. Intern Med 2011; 50:1993.
  31. Ladas SD, Triantafyllou K, Tzathas C, et al. Gastric phytobezoars may be treated by nasogastric Coca-Cola lavage. Eur J Gastroenterol Hepatol 2002; 14:801.
  32. Kato H, Nakamura M, Orito E, et al. The first report of successful nasogastric Coca-Cola lavage treatment for bitter persimmon phytobezoars in Japan. Am J Gastroenterol 2003; 98:1662.
  33. Chung YW, Han DS, Park YK, et al. Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola. Dig Liver Dis 2006; 38:515.
  34. Lee BJ, Park JJ, Chun HJ, et al. How good is cola for dissolution of gastric phytobezoars? World J Gastroenterol 2009; 15:2265.
  35. Harikumar R, Kunnel P, Sunilraj R. Dissolution of pharmacobezoar using carbonated beverage. Indian J Gastroenterol 2008; 27:245.
  36. Ladas SD, Kamberoglou D, Karamanolis G, et al. Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Aliment Pharmacol Ther 2013; 37:169.
  37. Holloway WD, Lee SP, Nicholson GI. The composition and dissolution of phytobezoars. Arch Pathol Lab Med 1980; 104:159.
  38. Zarling EJ, Thompson LE. Nonpersimmon gastric phytobezoar. A benign recurrent condition. Arch Intern Med 1984; 144:959.
  39. Walker-Renard P. Update on the medicinal management of phytobezoars. Am J Gastroenterol 1993; 88:1663.
  40. Schlang HA. Acetylcysteine in removal of bezoar. JAMA 1970; 214:1329.
  41. Silva FG, Gonçalves C, Vasconcelos H, Cotrim I. Endoscopic and enzymatic treatment of gastric bezoar with acetylcysteine. Endoscopy 2002; 34:845.
  42. Rider JA, Foresti-Lorente RF, Garrido J, et al. Gastric bezoars: treatment and prevention. Am J Gastroenterol 1984; 79:357.
  43. Zarling EJ, Moeller DD. Bezoar therapy. Complication using Adolph's Meat Tenderizer and alternatives from literature review. Arch Intern Med 1981; 141:1669.
  44. Naveau S, Poynard T, Zourabichvili O, et al. Gastric phytobezoar destruction by Nd:YAG laser therapy. Gastrointest Endosc 1986; 32:430.
  45. Benes J, Chmel J, Jodl J, et al. Treatment of a gastric bezoar by extracorporeal shock wave lithotripsy. Endoscopy 1991; 23:346.
  46. Wang YG, Seitz U, Li ZL, et al. Endoscopic management of huge bezoars. Endoscopy 1998; 30:371.
  47. Blam ME, Lichtenstein GR. A new endoscopic technique for the removal of gastric phytobezoars. Gastrointest Endosc 2000; 52:404.
  48. Sechopoulos P, Robotis JF, Rokkas T. Gastric bezoar treated endoscopically with a carbonated beverage: case report. Gastrointest Endosc 2004; 60:662.
  49. Gold MH Jr, Patteson TE 3rd, Green GI. Cellulase bezoar injection: a new endoscopic technique. Gastrointest Endosc 1976; 22:200.
  50. Winkler WP, Saleh J. Metoclopramide in the treatment of gastric bezoars. Am J Gastroenterol 1983; 78:403.
  51. Stringel G, Parker M, McCoy E. Vinyl glove ingestion in children: a word of caution. J Pediatr Surg 2012; 47:996.
  52. Durkhure R, Singh JP, Singhal V. Cotton Bezoar--a rare cause of intestinal obstruction: case report. BMC Surg 2003; 3:5.