phytobezoars

Phytobezoars are masses of indigestible plant material that form within the gastrointestinal tract, most often in the stomach. They consist of plant fibers such as cellulose, hemicellulose, lignin, and tannins, and can arise from poorly chewed or high-fiber foods. A well-known subtype is the diospyrobezoar, associated with tannin-rich fruits such as persimmons.

Risk factors include prior gastric surgery (eg, gastrectomy, gastric bypass) that delays gastric emptying, a high-fiber diet, inadequate chewing, dehydration, and gastrointestinal motility disorders. Certain foods and reduced gastric acidity can also contribute. Phytobezoars may cause partial or complete gastric outlet obstruction or small-bowel obstruction if they migrate.

Clinical presentation varies from nonspecific upper abdominal discomfort, bloating, early satiety, and nausea to signs of obstruction such as vomiting and weight loss. Some bezoars are discovered incidentally during endoscopy or imaging.

Diagnosis commonly relies on endoscopy, which can confirm the presence of a bezoar and may allow fragmentation or removal. Imaging with CT can reveal a mottled intraluminal mass and help differentiate from other causes of obstruction. Endoscopic and radiologic findings together guide management.

Treatment ranges from non-surgical to surgical. Gastric phytobezoars may respond to endoscopic fragmentation and removal, enzymatic dissolution, or gastric lavage. Non-surgical dissolution with carbonated beverages (notably Coca-Cola) or enzymatic agents has been reported. If these measures fail or obstruction is complete, surgical removal via gastrotomy or enterotomy is required, sometimes laparoscopically. Prevention focuses on thorough mastication, gradual dietary fiber introduction, adequate hydration, and monitoring in patients with prior gastric surgery.