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Review
. 2015 Apr 16;7(4):336-45.
doi: 10.4253/wjge.v7.i4.336.

Review of the diagnosis and management of gastrointestinal bezoars

Masaya Iwamuro  1 , Hiroyuki Okada  1 , Kazuhiro Matsueda  1 , Tomoki Inaba  1 , Chiaki Kusumoto  1 , Atsushi Imagawa  1 , Kazuhide Yamamoto  1
Affiliations
Review

Review of the diagnosis and management of gastrointestinal bezoars

Masaya Iwamuro et al. World J Gastrointest Endosc. .

Abstract

The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus. A number of articles have emphasized the usefulness of Coca-Cola(®) administration for the dissolution of phytobezoars. However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars. Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management. Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars. Diagnosis and management strategies are also discussed, reviewing mainly our own case series. Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.

Keywords: Bezoars; Endoscopic removal; Gastric ulcer; Gastrointestinal endoscopy; Ileus; Persimmon phytobezoar; Trichobezoar.

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Figures

Figure 1
Figure 1
Endoscopic images of a persimmon phytobezoar. A: A large, black bezoar is seen in the gastric fundus; B: A peptic ulcer is also observed in the gastric angle; C: Fragmentation of the bezoar was performed by endoscopy forceps and polypectomy snares; D: The fragments were removed by a retrieval net device and used in the subsequent in vitro analysis.
Figure 2
Figure 2
Photographs of the in vitro experiment. A: Endoscopically extracted fragments of the gastric bezoar were used; B: Representative photographs of the bezoar fragments incubated at 37 °C with gentle swirling for 12 h with double-distilled water; C: Bezoar fragments after incubation with Coca-Cola®; D: Bezoar fragments after incubation with Coca-Cola Zero®; E: Bezoar fragments after incubation with a digestive enzymes supplement including cellulase; F: Bezoar fragments after incubation with papain. The bezoar fragments were clearly more softened and more fragmented after 12-h incubation with Coca-Cola® or Coca-Cola Zero® than with the other agents.
Figure 3
Figure 3
The dissolubility of bezoar fragments. The mean dissolubility of bezoar fragments was highest by Coca-Cola®, but the difference between Coca-Cola® and water was not significant (P = 0.06) due to the relatively large standard deviation. NS: Not significant. aP < 0.05.
See this image and copyright information in PMC

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