cellulase and Bezoars

Topics: Bezoars; Cellulase; Humans; Stomach

The purpose of this review article is to provide the clinician with complete information concerning available medicinal agents for the management of phytobezoars. Data sources were obtained by a Medline search from 1966 to present. All citations containing references to patients with a phytobezoar treated with medicinal agents were selected and reviewed for treatment regimen, number of patients treated, length of therapy, success rate, and adverse effects. A total of 36 patients with phytobezoars were reviewed. Papain was successful in treating 87% (13 of 15) and cellulase in 100% (19 of 19) of the patients. Adverse effects reported in the papain group were gastric ulcer, esophageal perforation, and hypernatremia; the cellulase group did not report any adverse effects. Papain and cellulase appeared to be effective in the management of phytobezoars in the small number of patients studied. However, controlled clinical trials are needed to compare the safety and efficacy of the two agents.

Topics: Acetylcysteine; Bezoars; Cellulase; Humans; Metoclopramide; Papain

The aim of our study was to analyze the efficacy of cellulase in dissolving gastric phytobezoars.. We carried out a prospective study over a period of 1 year. All patients (7 cases) diagnosed as having gastric phytobezoar on gastroscopy were treated with cellulase.. Complete dissolution of the gastric phytobezoar was achieved in all 7 patients. No side effects or recurrences occurred during follow-up.. We conclude that cellulase should be regarded as the treatment of choice for gastric phytobezoars because of its efficacy, and because of the lack of side effects or recurrences. However, further clinical trials are necessary to verify these findings.

Topics: Adult; Aged; Bezoars; Cellulase; Female; Humans; Male; Middle Aged; Prospective Studies; Stomach

Two cases of a chemical dissolution of gastric phytobezoars are presented. The novel approach of that management is the pharmacological mixture than completely made disappear the bezoars in patients fated to surgery removal.

Topics: Bezoars; Carbonated Beverages; Cellulase; Drug Therapy, Combination; Gastrointestinal Agents; Humans; Pancreatin; Stomach Diseases; Treatment Outcome; Ursodeoxycholic Acid

Topics: Aged; Bezoars; Carbonated Beverages; Cellulase; Diospyros; Humans; Male; Papain; Solubility; Stomach

Persimmon phytobezoar, although an infrequent entity, is not rare in some countries. Because of their particular features, management of diospyrobezoars is difficult. A number of surgical, endoscopic, and pharmacologic treatments have been proposed with variable success. This is a description of our experience with 10 patients with a new combination therapy.. Ten patients (7 men, 3 women; mean age 46.4 years) were treated with a new fragmentation technique consisting of a saw-like effect with a large polypectomy snare followed by administration of cellulase, cysteine, and metoclopramide.. Resolution was achieved in 8 patients. Complications (intestinal obstruction) developed in 2 patients.. Our combined therapy is safe and highly efficacious but caution must be exercised because intestinal obstruction can occur if large fragments pass through the pylorus. A more extensive study is required to assess these clinical observations.

Topics: Bezoars; Cellulase; Combined Modality Therapy; Cysteine; Diospyros; Endoscopy, Gastrointestinal; Female; Gastrointestinal Agents; Humans; Male; Metoclopramide; Middle Aged; Stomach

A 66-year-old woman had a sudden onset of small-bowel obstruction during enzymatic treatment for gastric persimmon bezoar. Oral enzymatic therapy is the most effective method of treatment for large phytobezoars when endoscopic extraction is not possible. However, this report suggests that a further endoscopic intervention may be necessary in case the dissolved bezoars cause small-bowel obstruction during this form of therapy.

Topics: Aged; Bezoars; Cellulase; Female; Fruit; Gastrointestinal Agents; Humans; Intestinal Obstruction; Jejunal Diseases; Pancreatin; Pepsin A; Stomach; Ursodeoxycholic Acid

Topics: Bezoars; Cecum; Cellulase; Humans; Papain

Topics: Aged; Aged, 80 and over; Bezoars; Cellulase; Female; Humans; Male

Topics: Acetylcysteine; Bezoars; Cellulase; Drug Therapy, Combination; Female; Humans; Metoclopramide; Middle Aged

Phytobezoars are intragastric concretions composed of food or persimmon fruit. Previous studies of patients with phytobezoars have had a preponderance of patients with persimmon phytobezoars; little clinical information is available regarding nonpersimmon phytobezoars. We report the cases of 52 patients with nonpersimmon phytobezoars and contrast our experience with that previously reported for patients with persimmon phytobezoars. Our patients experienced pain (67%), nausea and vomiting (50%), diarrhea (13%), and gastric ulcers (14%). No patient with a phytobezoar died. Two thirds of our patients had conditions that could alter gastric motility. Medical therapy successfully dissolved 91% of the phytobezoars. One fifth of our patients had a phytobezoar redevelop. Compared with patients with persimmon phytobezoars, we conclude that patients with nonpersimmon phytobezoars have (1) different symptoms, (2) a low risk of complications or death, (3) effective medical therapeutic options, and (4) a 19% risk of phytobezoar recurrence.

Topics: Adult; Aged; Bezoars; Cellulase; Endoscopy; Female; Fruit; Humans; Male; Middle Aged; Papain; Recurrence; Stomach

Gastric bezoars may occur in the normal stomach as a result of ingestion of various objects which do not pass through the pylorus. Most gastric bezoars occur as a complication of previous gastric surgery in which there is a loss of normal pyloric function, hypoperistalsis, and low gastric acidity. They may also occur as a complication of cimetidine therapy. Symptoms include epigastric fullness, regurgitation, nausea and vomiting, and epigastric pain. A simple treatment utilizing an ordinary Teledyne Water Pik jet stream through a gastroscope is described to break up a large phytobezoar. This method is probably the treatment of choice and should be used more widely.

Topics: Adult; Bezoars; Cellulase; Female; Gastric Lavage; Gastroscopy; Humans; Papain; Postoperative Complications; Stomach

Topics: Bezoars; Cellulase; Humans; Ileal Diseases; Intestinal Obstruction; Male; Middle Aged; Stomach

Topics: Adolescent; Adult; Bezoars; Cellulase; Humans; Male; Papain; Stomach

A case of phytobezoar in a gastrectomized patient with liver disorders is reported. Owing to the difficulty of establishing the diagnosis, the need for gastroscopy and biopsy is emphasized. Apart from the cases in which surgical removal is urgent, attention is drawn to the effectiveness of enzyme dissolution in connection with the experience described.

Topics: Bezoars; Bile; Biopsy; Cellulase; Gastrectomy; Gastroscopy; Humans; Liver; Liver Diseases; Male; Middle Aged; Pepsin A

The plant fiber content (cellulose, hemicellulose, lignin, and tannins) in phytobezoars was determined. Phytobezoars were found to have a high concentration of polymerized tannins composed mainly of leucoanthocyanins and catechins. Unripe fruit was found to have a high concentration of the tannin monomers. It is concluded that the formation of phytobezoars is due to the polymerization of these tannin monomers. On the ingestion of unripe fruit, the hydrochloric acid of the stomach initiates the polymerization, resulting in a tannin-cellulose-hemicellulose-protein complex. This complex disintegrated in a crude preparation of cellulase. Cellulase is a simple and effective method of treating human gastric phytobezoars.

Topics: Bezoars; Cellulase; Cellulose; Chromatography, Thin Layer; Fruit; Humans; Lignin; Tannins; Time Factors

Topics: Adult; Bezoars; Cellulase; Female; Humans; Male; Middle Aged

Topics: Bezoars; Cellulase; Female; Humans; Middle Aged; Stomach Diseases; Vegetables

Topics: Adult; Aged; Bezoars; Cellulase; Endoscopy; Female; Humans; Male

Phytobezoars are plant fibre concretions occurring in the stomach as a complication following some types of gastric surgery. Symptoms include distension, pain and vomiting. Ulceration, gastric bleeding and even perforation can occur. If untreated, they result in a significant mortality. Dissolution of the phytobezoar can be achieved without operative intervention. Enzymes and especially cellulase help to break up the mass and it can then be aspirated or allowed to pass on. Five patients with phytobezoars were thus treated and the cellulase method was confirmed to be simple, safe and effective.

Topics: Adult; Aged; Bezoars; Cellulase; Gastrectomy; Humans; Male; Middle Aged; Plants; Postoperative Complications; Time Factors

Topics: Aged; Bezoars; Cellulase; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications

Topics: Aged; Bezoars; Cellulase; Endoscopy; Female; Glycoside Hydrolases; Humans; Injections; Middle Aged

Phytobezoar occurring as a complication of gastric carcinoma is reported for the first time. A review of the pathogenesis of phytobezoar suggests that hypomotility and hyposecretion are the two most important factors in bezoar formation. In the case discussed, hypomotility as a consequence of neoplastic involvement of the gastric antrum was the most important precipitating factor. However, documentation of prior hyposecretion was also noted and suggests that a combination of these two factors may be more significant than each taken alone. The therapeutic management of bezoars in patients who are not candidates for surgery is frequently difficult. This is the third case in which the enzyme cellulase has been used successfully for bezoar dissolution.

Topics: Adenocarcinoma, Scirrhous; Aged; Anemia, Pernicious; Bezoars; Biopsy; Cellulase; Female; Gastric Mucosa; Gastrointestinal Motility; Humans; Hypothyroidism; Multiple Myeloma; Radiography; Stomach Neoplasms; Vegetables

A review of phytobezoars is presented, emphasizing medical treatment using enzymatic dissolution for bezoar located in the gastric pouch. Clinical and in vitro studies show the efficacy of both papain and cellulase, and it is suggested that, since each acts on a different component of the bezoar, they be administered in combination. There were no complications with this treatment in the patients reported in this series.

Topics: Bezoars; Cellulase; Drug Therapy, Combination; Enzyme Therapy; Humans; Ileum; Intestinal Diseases; Papain; Pepsin A; Plants, Edible; Stomach Diseases

In a female patient anaemia due to chronic blood loss occurred after gastrectomy and subsequent vagotomy. Gastroscopy showed a phytobezoar to be the cause. In a second patient who had not had gastric surgery a phytobezoar was found as well as a prepyloric ulcer during investigations for upper abdominal symptoms. In both cases the phytobezoars could be removed completely within a short time after dissolution by an oral cellulase containing enzyme preparation and gastroscopic breaking-up.

Topics: Adult; Bezoars; Cellulase; Female; Gastroscopy; Glycoside Hydrolases; Humans; Middle Aged; Plants; Postgastrectomy Syndromes; Stomach; Stomach Ulcer; Vagotomy

Topics: Acetylcysteine; Antifungal Agents; Bezoars; Bicarbonates; Bromelains; Cellulase; Female; Gastric Lavage; Gastroscopy; Humans; Papain; Sodium; Stomach Diseases

Topics: Bezoars; Cellulase; Duodenal Ulcer; Glycoside Hydrolases; Humans; Male; Middle Aged; Postoperative Complications; Vegetables

Topics: Bezoars; Cellulase; Glycoside Hydrolases; Humans; Male; Middle Aged