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PubMed1989

Pharmacological study of a traditional Chinese medicine: effect of bezoar bovis on the irregular beating pattern of cultured mouse myocardial cells.

The water-extract from "Bezoar bovis", a drug used in Chinese traditional medicine, was examined for its ability to alter the beating pattern of spontaneously contracting cultured embryonic mouse myocardial cells following changes in extracellular calcium (Ca2+). Incubation of the cells with medium containing low Ca2+ concentration (0.4 mM) caused the number of beating cells and beating rate to decrease and the number of arrhythmic cells to increase. By contrast, the number of beating cells decreased while beating rate and the number of arrhythmic cells increased at high Ca2+ (20 mM). Addition of Bezoar bovis extract to the medium attenuated the response to varying Ca2+ concentration. One of the major constituents of Bezoar bovis extract, taurine, was effective in protecting against the abnormal beating pattern induced by high Ca2+. Since beta-alanine, an inhibitor of taurine transport, antagonized the protective effects of both Bezoar bovis and taurine, it is likely that the effect of Bezoar bovis is partially mediated by taurine.

Alanine↗
PubMedDate not supplied

The fascinating history of bezoars.

The word "bezoar" is derived from the Arabic "bazahr" or "badzehr", which means antidote or counter-poison; animal bezoars were widely used in medicine until the 18th century. Trichobezoars (hair), phytobezoars (vegetable matter) or combinations of both (trichophytobezoars) may be found in the gastrointestinal tract of humans. While the prevalence of bezoars in humans is low, mortality rates may be as high as 30% if they remain untreated, mainly through gastrointestinal bleeding, destruction or perforation. Endoscopic treatment of gastric bezoars has made inroads into the traditional treatment of bezoars by surgical removal.

Bezoars↗
PubMed1999

Endoscopic treatment of bezoars. A critical review of the literature and presentation of two cases.

The authors report two cases of bezoars. The first was a large gastric bezoar in a patient who had undergone Billroth II gastroresection 40 years earlier. The second was a bezoar located in the distal part of the sigmoid colon accompanied by acute diverticular disease. Both bezoars were removed using endoscopic techniques. The method of exeresis is described together with the characteristics of the different anatomic sites. The authors review the literature focusing on nosology, symptomatology, diagnosis and guidelines for therapy. Considerable attention is paid to the use of endoscopy associated with prokinetic-enzymatic medical therapy. Surgery is reserved for rare cases of endoscopic failure, mostly recorded in the event of trichobezoars following the onset of intestinal occlusions caused by migration, or lastly when the cause of the bezoar is a pre-existing organic or functional stenosis.

Journal Article↗
PubMed2003

Laparoscopic removal of a large gastric bezoar in a mentally retarded patient with pica.

Whereas small gastric bezoars may be removed endoscopically, large bezoars traditionally are removed at laparotomy. We describe a 33-year-old mentally retarded woman with pica syndrome who had experienced episodes of upper abdominal pain and distension of 10 months duration. Gastroscopy showed a large bezoar in the stomach, and attempted endoscopic removal was unsuccessful. The patient underwent laparoscopic extraction of the bezoar, which proved to be an ingested glove. She made an uneventful recovery and was discharged home on postoperative day 1. She had no wound complications, and her symptoms had not recurred at a 3-month follow up assessment. The operative technique is described, and the merits of the laparoscopic approach are discussed.

Adult↗
PubMed2006

Postoperative bezoar ileus after early enteral feeding.

Postoperative enteral nutrition is a widely accepted route of application for nutrition formulas due to a low complication rate, a good acceptance by patients. and a favorable cost-effectiveness. We report three cases of bezoar ileus after early postoperative enteral nutrition, using a fine needle jejunostomy (FNJ) in two cases and a nasoduodenal tube in one case. A male patient who underwent gastric resection for a gastrointestinal stroma tumor and was nourished through an fine needle jejunostomy developed an acute abdomen on the seventh postoperative day. Surgical exploration revealed a mechanical ileus caused by denaturated nutrition formula distal to the catheter tip. The second case, a female patient, underwent gastric resection for a gastric cancer and on the fourth postoperative day developed acute onset of abdominal pain. Intraoperative findings were the same as described in the first case. The third case, a male patient with necrotizing cholecystitis, underwent open cholecystectomy. Postoperative enteral feeding was performed using a nasoduodenal tube. He developed a small bowel obstruction on the 17th postoperative day that was caused by an intraluminal bezoar. In conclusion, bezoar formation represents an underestimated complication of postoperative enteral feeding. Acute onset of abdominal pain and the development of small bowel obstruction are the main clinical symptoms of this severe complication. The pathogenesis of bezoar formation remains unclear.

Adult↗
PubMed1990

Fungal bezoars of the upper urinary tract.

We report our experience with 6 cases of upper tract fungal bezoars involving 9 renal units-3 bilateral aspergillomas and 3 Candida bezoars. The Aspergillus bezoars were notably more morbid: 2 patients required nephrectomy after failure of medical therapy, whereas the 3 unilateral Candida bezoars all resolved with medical therapy and endourological access. In 1 patient whose aspergilloma was resistant to amphotericin B the investigational drug itraconazole proved effective. These opportunistic infections, seen increasingly in immunocompromised patients, can present a difficult management problem. A combined approach is necessary, including medical therapy with topical and systemic antifungal agents, and endourological access for extraction, lavage and debulking.

Adult↗
PubMed1997

[Esophageal bezoar in a child treated with sucralfate].

BACKGROUND: Sucralfate is widely used in stress bleeding prophylaxis in intensive care units as it causes relatively few side effects. Its use in patients with risk factors may lead to the formation of esophageal bezoar. We describe the first known pediatric case of sucralfate esophageal bezoar. CASE REPORT: A 11-year-old girl presented with severe encephalitis complicated by seizures. She was treated in an intensive care unit by restrictive hydration associated with sucralfate, morphinic compound, phenobarbital and curare. At day 10, enteral feeding through a nasogastric tube was started. Five days later, an esophageal bezoar was diagnosed, which disappeared after discontinuing sucralfate, morphinic compound, curare and enteral feeding. CONCLUSIONS: Risk factors, similar to those reported in adults with esophageal bezoars, were found in this patient ie, plurimedication, dehydration, impaired gastric motility. Caution should be taken when combining enteral feeding and sucralfate whenever any additional risk factor is present.

Anti-Ulcer Agents↗
PubMed1991

Treatment of a gastric bezoar by extracorporeal shock wave lithotripsy.

A bezoar of the stomach was diagnosed by X-ray and endoscopy in an 8-year-old boy who presented with intermittent dull epigastric pain. Attempts at endoscopic extraction failed because of the size and hardness of the bezoar. Extracorporeal shock wave lithotripsy was therefore applied using ultrasound to locate the bezoar. Disintegration of the bezoar and spontaneous evacuation of the fragments was achieved.

Bezoars↗
PubMed1985

Bezoars--when the 'knot in the stomach' is real.

Bezoars, gastric or intestinal concretions of undigested fruit fibers, vegetable matter, or human hair, can cause acute obstruction or long-term interference with normal digestion and absorption of nutrients. Likelihood of bezoar formation is increased in patients who have undergone gastrointestinal surgery. In particular, patients who have had gastric reduction for morbid obesity may form a high-risk population. Certain diseases or medicines also can predispose to bezoar formation. Except in emergencies, when surgical removal is necessary, dissolution of bezoars by various enzymatic preparations is the currently accepted treatment.

Bezoars↗
PubMedDate not supplied

Esophageal bezoar formation in a tube-fed patient receiving sucralfate and antacid therapy: a case report.

In this case report, the authors describe an esophageal bezoar found in a mechanically ventilated patient receiving sucralfate, antacid, and tube feeding via a nasogastric tube. The presence of a prosthetic device in the esophagus (such as a nasogastric or endotracheal tube) in conjunction with functional esophageal abnormalities is a common link in the development of esophageal bezoars. These bezoars form in the esophagus as a result of regurgitation of stomach contents. In addition, bezoars are a known complication of gastric motility disorders, such as gastric paresis of diabetes. Critically ill patients are frequently given antacid and sucralfate therapy while being enterally tube fed, often by nasogastric tubes. This combination of treatment modalities in patients with esophageal and/or neurological abnormalities warrants vigilant adherence to measures to prevent reflux and gastric pooling.

Aged↗
PubMed1979

Management of persimmon bezoars (diospyrobezoars).

Since 1946, 20 men and one woman aged 40 to 76 years (average 57) were operated upon for complications of diospyrobezoars. Shortly after eating persimmons, 11 (52.4%) had severe abdominal cramping, anusea, vomiting, and pyrexia. Twelve of 17 (70.9%) with gastric bezoars had hematemesis or melena caused by an associated gastric ulcer, while five (29.1%) had only moderate dyspepsia. In four (19.1%), the bezoar had lodged in the ileum, causing obstruction. Enzymatic therapy is indicated in those with minor symptoms. Gastrotomy or gastrotomy with bezoar removal and wedge resection of the gastric ulcer is recommended when enzymatic therapy fails, or when there is gastric outlet obstruction or marrise hemorrhage. Emergency exploration with removal is necessary when the persimmon bezoar causes ileal obstruction.

Adult↗
PubMed1992

Cecal vitamin bezoar formation inducing abdominal discomfort.

OBJECTIVE: To document a case of cecal lecithin-vitamin B12 bezoar formation inducing abdominal discomfort. DESIGN: Case study. SETTING: 500-bed, community teaching hospital. PATIENT: 81-year-old man with a history of multiple abdominal surgeries who presented with a chief complaint of abdominal pain. Flat plate X-ray of the abdomen revealed multiple capsule-shaped objects lodged in the cecum. INTERVENTIONS: Catharsis with bisacodyl, magnesium citrate, NaCl 0.9%; dissolution with heated, dilute barium administered rectally in conjunction with external manipulation; laparotomy. MAIN OUTCOME MEASURES: None planned; dissolution or transit of bezoar through gastrointestinal tract desired outcome. RESULTS/DISCUSSION: Classification of bezoars and treatment discussed in relation to this case report. CONCLUSIONS: Medicinal agents have been implicated in bezoar formation. Treatment options have included: cathartics, heated solvent enemas, and external manipulation and surgery.

Abdominal Pain↗
PubMedDate not supplied

[Sucralfate and bezoars: data from the system of pharmacologic vigilance and review of the literature].

A bezoar is a mass of undigested material which may form within the lumen of the gut. Some drugs have the potential to form bezoars. In the majority of patients, there is a clear predisposing factor. We present here the data of the French System of Pharmacovigilance on sucralfate and a literature review. Two distinct populations were involved: 16 adults and 5 newborn babies. All were hospitalized in intensive care units. The children were very low birth weight newborn babies, all of whom presented with abdominal distension or acute occlusion. The abdominal radiograph revealed an opaque mass filling the contour of the stomach. Adults presented an oesophageal bezoar around a nasogastric tube. Risk factors for bezoar formation were severe illness, gut hypomotility, dehydration, overdosage, nasogastric tube feeding. Sucralfate is used in the management of peptic ulcer. At pH < 4, extensive polymerization occurs and a sticky viscid gel is formed. In view of this inquiry, the French System of Pharmacovigilance decided to advise caution for adults in intensive care unit being fed by nasogastric tube and contraindication in premature babies and dysmature newborn babies receiving sucralfate.

Adult↗
PubMedDate not supplied

[Gastric foreign body: bezoars. Apropos of two cases].

OBJECTIVE: The authors report their experience about the treatment of two cases of gastric bezoar, treated in curative mode, the first endoscopically and the second with surgical intervention. SETTING: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation, Policlinico, University of Palermo. INTERVENTION: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical fragmentation of phytobezoar and fragments extraction via-overtube), the second with surgical gastrotomy (stamp trichobezoar). There were no procedure-related complications. RESULTS: The two patients were curative and radically treated. Negative 2 years follow-up. CONCLUSIONS: There is no standardized method for the treatment of gastric bezoars. Endoscopic removal of gastric bezoars after fragmentation and using overtube is effective and safe. Surgical intervention, equally safe, is reserved to huge, stamp, impacted or complicated bezoars.

Adult↗
PubMed1988

Bezoars: classification, pathophysiology, and treatment.

Bezoars, accumulations of foreign material in the stomach, have been known to occur in animals and man for centuries. The incidence of bezoars in human patients has increased as a result of operative manipulation of the gastrointestinal tract. Composed of vegetable matter, hair, or more unusual materials like shellac or cement, they may lead to anorexia, weight loss, bleeding, obstruction, or perforation of the alimentary tract. Although this entity is often recognized radiologically, endoscopy provides the most accurate means for identification and classification. Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Physicians must learn to recognize and classify bezoars correctly in order to provide the most appropriate therapy in each instance.

Bezoars↗
PubMed1987

Association of diabetes mellitus with gastric bezoar formation.

The association of diabetes mellitus with gastric bezoars is not well documented. Our endoscopic experience over a seven-year period (1979 to 1985) included 3247 esophagoduodenoscopies (EGDs). Bezoars were found in 14 patients (0.4%). The mean age of these 14 patients was 63 years (range, 27 to 84 years); there were eight men and six women. In 11 patients, there was a history and/or findings of peptic ulcer disease (PUD). Two patients had prior surgery (Billroth II in one and vagotomy in another). Seven patients had diabetes mellitus; five had diabetes for over five years, and three of these five had diabetes for over ten years. Diabetes was newly diagnosed in one patient. Except for the newly diagnosed patient, the other diabetic patients had evidence of autonomic neuropathy. Two other patients (not included with the diabetic patients) had hyperglycemia only during stress. The three patients with bezoars but without PUD all had diabetes for many years (9, 17, and 19 years). In two control groups of 14 patients each who also underwent endoscopy, only one diabetic patient was discovered. We conclude that diabetes mellitus and associated gastropathy are major risk factors for bezoar formation, especially in the absence of PUD.

Adult↗
PubMed1983

Metoclopramide in the treatment of gastric bezoars.

The effect of metoclopramide as an adjunct to the conventional treatment of gastric bezoars was studied. All patients received conventional endoscopic treatment which consisted of mechanical fragmentation and the instillation of papain solution. Fifteen patients received only endoscopic treatment while nine patients were given, in addition, metoclopramide 10 mg orally before meals and at bedtime. The conventionally treated group required a mean of 1.9 courses of endoscopic treatments, while the metoclopramide treated group required a mean of 1.2 courses to resolve the bezoar. This difference was statistically significant. It was also found that long-term metoclopramide treatment reduced the frequency of bezoar formation in four patients with recurrent gastric bezoars.

Bezoars↗
PubMed1981

[Gastric bezoar in diabetes mellitus. 3 cases (author's transl)].

Diabetic gastroparesis is the gastric manifestation of diabetic autonomic neuropathy and may result, on rare occasions, in the formation of a bezoar. This was the case in 3 patients (two women aged 36 and 66 and a 19-year-old man) whose insulin-dependent diabetes was complicated with neuropathy. All patients had marked glycaemic instability apparently related to digestive function. In one patient, a stable normoglycaemic state was obtained by continuous intravenous administration of carbohydrates until the bezoar had disappeared. In the other two patients, who had a long history of neglected digestive disorders, the bezoars provided intractable. In diabetics with dyspeptic symptoms, and particularly when neuropathy is present, it would be advisable to investigate for gastroparesis in order to prevent the development of a bezoar by dietetic and therapeutic measures.

Adult↗