gastrointestinal disorders
Bezoars
Treatment of Bezoars
Chemical dissolution Endoscopic removal Sometimes surgery The optimal therapeutic intervention is controversial because randomized controlled trials comparing different options have not been done. Sometimes, combination therapy is required. using agents such as cola and cellulase can be done for patients with mild symptoms ( Treatment references ). Cellulase dosage is 3 to 5 g dissolved in 300 to 500 mL of water; this is taken over the course of a day for 2 to 5 days. is indicated for patients who have bezoars that fail to dissolve, moderate to severe symptoms due to large bezoars, or both. If initial diagnosis is made by endoscopy, removal can be attempted at that time. Fragmentation with forceps, wire snare, jet spray, argon plasma coagulation, or even laser ( Treatment references ) may break up bezoars, allowing them to pass or be extracted. Surgeryis reserved for cases in which chemical dissolution and endoscopic intervention cannot be done or have failed, for patients with complications, or for patients with intestinal bezoars. Persimmon fruit bezoars are usually hard and difficult to treat because persimmons contain the tannin shibuol, which polymerizes in the stomach. They do not respond well to chemical dissolution and usually require endoscopic or surgical removal. 1.Iwamuro M, Okada H, Matsueda K, et al: Review of the diagnosis and management of gastrointestinal bezoars.World J Gastrointest Endosc7(4):336–345, 2015. doi: 10.4253/wjge.v7.i4.336 2.Mao Y, Qiu H, Liu Q, et al: Endoscopic lithotripsy for gastric bezoars by Nd:YAG laser-ignited mini-explosive technique.Lasers Med Sci29:1237–1240, 2014. doi: 10.1007/s10103-013-1512-1 