Gastric phytobezoar dissolution with ingestion of diet coke and cellulase.

Address correspondence to: Dr. Mark B. Pochapin, NYU Langone Medical Center, 522 First Avenue, Suite 901B, New York, NY 10016; Tel: 646-501-6760; Fax: 646-501-6767; E-mail: [email protected] A bezoar is an indigestible mass of material—such as hair, food, seeds, or another ingested substance—found in the gastrointestinal tract.1 A phytobezoar, the most common type of bezoar, is composed of indigestible fruit and vegetable fibers, such as cellulose, hemicellulose, lignin, or tannins. Most phytobezoars occur in patients who have impaired gastric motility or digestion, usually following gastric surgery (such as a Billroth I or II gastrectomy) or as a consequence of impaired motility in patients with diabetic gastroparesis, mixed connective tissue disease, or hypothyroidism.2,3 Impaired gastric peristalsis, low gastric acidity, and loss of normal pyloric function can all contribute to phytobezoar formation.4 Patients with phytobezoars may experience epigastric pain or discomfort, nausea, vomiting, early satiety, weight loss, diarrhea, dysphagia, or upper gastrointestinal ulcerations and hemorrhage.1,2 Prior to the 1960s, phytobezoars were often treated with surgery; however, a wide variety of therapeutic options have since been reported, including medical treatment with cellulase, papain, metoclopramide, or N-acetylcysteine.1,2,4-6 Surgical intervention is still sometimes necessary, and endoscopic removal has also been used.7-9 Recently, the carbonated beverage Coca-Cola (The Coca-Cola Company) has been successfully used to dissolve bezoars.3 We report 3 patients with gastric phytobezoars who were successfully treated with a combination of Diet Coke (The Coca-Cola Company) and cellulase.