Successful treatment with pineapple juice of a gastric bezoar caused by mastic.

A 59-year-old man was admitted to our department with epigastric pain and nausea. The patient mentioned that he had swallowed heated mastic to treat constipation shortly before his symptoms developed. He had no history of any diseases. His vital signs were within normal limits. The physical examination findings were normal, and the results of laboratory tests were unremarkable. Upper gastrointestinal endoscopy revealed a gastric bezoar 6 to 7cm in diameter (●" Fig.1). Although there is uncertainty concerning the volume of pineapple juice, we recommended that our patient drink 1L of fresh pineapple juice 3 times a day (once after each meal) for the next 2 weeks. The patient again underwent upper gastrointestinal endoscopy after the ingestion of fresh pineapple juice. We found that the gastric bezoar had dissolved completely (●" Fig.2), so that surgery could be avoided. Gastric bezoars are unusual. They are frequently associated with peptic ulcer, diabetes mellitus, or gastric surgery. In the medical literature, many invasive and noninvasive methods to dissolve gastric bezoars, such as mechanical fragmentation and medical treatment, have been described [1,2]. The consumption of pineapple juice as a noninvasive method to dissolve bezoars has also been reported [3]. The putative mechanism of dissolution is that pineapple juice is rich in bromelain, a proteolytic enzyme. We are the first to report the administration of pineapple juice to dissolve a gastric bezoar caused by swallowing heated mastic.