Phytobezoar

Phytobezoar is a type of bezoar, which is a mass found trapped in the gastrointestinal system. Unlike other bezoars, a phytobezoar is specifically composed of indigestible plant material. The term originates from the Greek words phyton meaning plant, and bezaar meaning a counter-poison or antidote. Phytobezoars are among the most common types of bezoars, and their formation is often associated with the consumption of fibrous foods such as celery, pumpkin, prunes, raisins, leeks, beets, persimmons, and sunflower seed shells.

Causes

Phytobezoars form when fibrous plant materials accumulate in the stomach and fail to pass through the digestive tract. This can be due to several factors including decreased gastric motility, previous gastric surgeries that alter the anatomy and function of the gastrointestinal tract, and certain eating habits. Individuals who have undergone surgeries like gastrectomy or those with conditions that slow gastric emptying, such as diabetes mellitus, are at a higher risk of developing phytobezoars.

Symptoms

The symptoms of a phytobezoar can vary depending on its size and location within the gastrointestinal tract. Common symptoms include abdominal pain, nausea, vomiting, gastric outlet obstruction, and in severe cases, gastrointestinal bleeding or perforation. Patients may also experience weight loss, anorexia, and signs of nutrient deficiencies as a result of impaired digestion and absorption.

Diagnosis

Diagnosis of a phytobezoar involves a combination of patient history, physical examination, and imaging studies. Endoscopy is the most definitive diagnostic tool, allowing direct visualization of the bezoar. Other imaging modalities such as X-rays, ultrasound, and CT scans can also suggest the presence of a bezoar but are less specific than endoscopy.

Treatment

Treatment options for phytobezoars depend on the size, location, and symptoms caused by the bezoar. Small, asymptomatic bezoars may be managed conservatively with observation and dietary modifications to prevent further accumulation. For symptomatic or larger bezoars, endoscopic removal is the preferred method. In cases where the bezoar cannot be removed endoscopically, or if there is evidence of gastrointestinal obstruction, perforation, or bleeding, surgical intervention may be necessary. Additionally, enzymatic dissolution therapy using agents such as cellulase can be effective in some cases.

Prevention

Prevention of phytobezoars primarily involves dietary modifications to avoid excessive intake of high-fiber foods known to contribute to bezoar formation. Individuals at higher risk, such as those with previous gastrointestinal surgery or motility disorders, should be particularly cautious. Regular follow-up and monitoring may also be recommended for at-risk individuals to prevent the recurrence of phytobezoars.

See Also

• Bezoar
• Gastrointestinal tract
• Gastrectomy
• Diabetes mellitus
• Endoscopy