Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2015; 7(4): 336-345
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.336
Review of the diagnosis and management of gastrointestinal bezoars
Masaya Iwamuro, Hiroyuki Okada, Kazuhiro Matsueda, Tomoki Inaba, Chiaki Kusumoto, Atsushi Imagawa, Kazuhide Yamamoto
Masaya Iwamuro, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
Hiroyuki Okada, Department of Endoscopy, Okayama University Hospital, Okayama 700-8558, Japan
Kazuhiro Matsueda, Department of Gastroenterology, Kurashiki Central Hospital, Okayama 710-8602, Japan
Tomoki Inaba, Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan
Chiaki Kusumoto, Department of Gastroenterology, Nippon Kokan Fukuyama Hospital, Fukuyama 721-0927, Japan
Atsushi Imagawa, Department of Gastroenterology, Mitoyo General Hospital, Kan-onji 769-1695, Japan
Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
Author contributions: Iwamuro M and Okada H designed the research study and wrote the paper; Matsueda K, Inaba T, Kusumoto C and Imagawa A made the endoscopic diagnoses and critically reviewed the manuscript for important intellectual content; Yamamoto K approved the manuscript.
Conflict-of-interest: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Masaya Iwamuro, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan. iwamuromasaya@yahoo.co.jp
Telephone: +81-86-2357219 Fax: +81-86-2255991
Received: September 6, 2014
Peer-review started: September 6, 2014
First decision: September 28, 2014
Revised: October 19, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 16, 2015
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, Gastrointestinal endoscopy, Persimmon phytobezoar, Trichobezoar, Endoscopic removal, Gastric ulcer, Ileus

Core tip: Among the gastrointestinal bezoars, phytobezoars, which consist of indigestible plant materials, are the most common. An administration of Coca-Cola® is believed to be the primary choice for phytobezoar treatment because it is safe, inexpensive, and effective. However, persimmon phytobezoars (diospyrobezoars) are often resistant to Coca-Cola® dissolution and may require different treatment. Endoscopic fragmentation or surgical removal should be applied in urgent cases, such as those manifesting gastrointestinal bleeding and/or ileus, and in patients with refractory bezoars.