Carbonated soda treatment of phytobezoars is the use of carbonated soda to try to dissolve a

phytobezoar A phytobezoar is a type of bezoar, or trapped mass in the gastrointestinal system, that consists of components of indigestible plant material, such as fibres, skins and seeds. While phytobezoars may be discovered incidentally on barium x-ray or e ...

. Bezoars consist of a solid and formed mass trapped in the

gastrointestinal system The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

, usually in the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

. These can also form in other locations. Carbonated soda has been proposed for the treatment of gastric phytobezoars. In about 50% of cases studied, carbonated soda alone was found to be effective in gastric phytobezoar

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. Unfortunately, this treatment can result in the potential of developing small bowel obstruction in a minority of cases, necessitating surgical intervention. It is one of many other stomach disorders that can have similar symptoms. Gastric phytobezoars are a form of

intestinal The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

blockage and are seen in those with poor gastric motility. The preferred treatment of bezoars includes different therapies and/or fragmentation to avoid surgery. Phytobezoars are most common and consist of various undigested substances including lignin,

cellulose Cellulose is an organic compound with the formula , a polysaccharide consisting of a linear chain of several hundred to many thousands of β(1→4) linked D-glucose units. Cellulose is an important structural component of the primary cell w ...

tannin Tannins (or tannoids) are a class of astringent, polyphenolic biomolecules that bind to and precipitate proteins and various other organic compounds including amino acids and alkaloids. The term ''tannin'' (from Anglo-Norman ''tanner'' ...

celery Celery (''Apium graveolens'') is a marshland plant in the family Apiaceae that has been cultivated as a vegetable since antiquity. Celery has a long fibrous stalk tapering into leaves. Depending on location and cultivar, either its stalks, ...

, pumpkin skin,

grape A grape is a fruit, botanically a berry, of the deciduous woody vines of the flowering plant genus '' Vitis''. Grapes are a non- climacteric type of fruit, generally occurring in clusters. The cultivation of grapes began perhaps 8,000 years a ...

skins,

prune A prune is a dried plum, most commonly from the European plum (''Prunus domestica''). Not all plum species or varieties can be dried into prunes. A prune is the firm-fleshed fruit (plum) of '' Prunus domestica'' varieties that have a high so ...

raisin A raisin is a dried grape. Raisins are produced in many regions of the world and may be eaten raw or used in cooking, baking, and brewing. In the United Kingdom, Ireland, New Zealand, and Australia, the word ''raisin'' is reserved for the ...

s, vegetables and fruits. Phytobezoars can form after eating

persimmon The persimmon is the edible fruit of a number of species of trees in the genus '' Diospyros''. The most widely cultivated of these is the Oriental persimmon, ''Diospyros kaki'' ''Diospyros'' is in the family Ebenaceae, and a number of non-per ...

s and

pineapple The pineapple (''Ananas comosus'') is a tropical plant with an edible fruit; it is the most economically significant plant in the family Bromeliaceae. The pineapple is indigenous to South America, where it has been cultivated for many centuri ...

s. These are more difficult to treat and are referred to as diospyrobezoars.

Treatment

Carbonated soda may help to dissolve phytobezoars. It can be given by a naso-gastric tube in children. Carbonated soda can also be given by mouth and during

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...

. It is effective in about half of the cases. It promotes dissolution by endoscopic techniques in the majority of the patients left, leading to a final success rate up to 91.3%. In some cases, regular use of

Coca-Cola Coca-Cola, or Coke, is a carbonated soft drink manufactured by the Coca-Cola Company. Originally marketed as a temperance drink and intended as a patent medicine, it was invented in the late 19th century by John Stith Pemberton in Atlant ...

resulted in no recurrence 3–15 months after the first episode. Treatment has varied widely. Coca-Cola has been administrated either as drinking beverage or as lavage. Some are treated with various combinations of drink, injection and irrigation. The volume of Coca-Cola in treatment varies along with daily dose and time of treatment. Dosages varied from 500 mL up to 3000 mL and treatment period 24 hours to 6 weeks. When lavage is used, a double-lumen nasogastric tube or two separate tubes using 3000 mL of Coca-Cola is administered during a 12-hour period. Alternative treatments are the use of cellulase, acetylcysteine, papain, pancreatic enzymes, saline solution, 0.1 N HCl and sodium bicarbonate. The protocol for the treatment of phytobezoars with Coca-Cola, i.e., dosage and timing, has not been standardized; further investigation has been encouraged.

Contraindications

Trichobezoars do not respond to treatment with Coca-Cola but instead this type may have to be surgically removed. Persimmon diospyrobezoars sometimes are resistant to Coca-Cola and require a different treatment. This can include endoscopic fragmentation and/or surgical approaches especially in urgent cases where the patient exhibits gastrointestinal bleeding.

Adverse effects and interactions

Adverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation. These effects have not been observed with the use of Coca-Cola. Glucose levels during the administration of Coca-Cola have not been addressed.

Pharmacology and interactions

In addition to Coca-Cola,

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has been used to dissolve bezoars of the stomach. When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%. The mechanism by which Coca-Cola dissolves the bezoar is based upon its low pH, CO₂ bubbles, and sodium bicarbonate content. :::"...patients given a continuous infusion of Coca-Cola by nasogastric tube over 12 hours showed complete resolution of bezoars. If you cannot find a can of Coke, perhaps

Pepsi Pepsi is a carbonated soft drink manufactured by PepsiCo. Originally created and developed in 1893 by Caleb Bradham and introduced as Brad's Drink, it was renamed as Pepsi-Cola in 1898, and then shortened to Pepsi in 1961. History Pepsi wa ...

will do the trick, assuming it does not cause

dysPEPSIa Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier ...

." Some clinicians have described the mode of interaction is based upon the acidification of the gastric contents and the release of CO₂ that causes disintegration. Three and a half liters given nasogastrically over 12 hours has been found to dissolve these bezoars. Coca-Cola has a pH of 2.6. This is due to carbonic and

phosphoric acid Phosphoric acid (orthophosphoric acid, monophosphoric acid or phosphoric(V) acid) is a colorless, odorless phosphorus-containing solid, and inorganic compound with the chemical formula . It is commonly encountered as an 85% aqueous solution, w ...

which resemble gastric acid. Gastric acid is believed to facilitate the digestion of fibers. In Coca-Cola, NaHCO₃ has a mucolytic effect and CO₂ bubbles enhance dissolving the bezoar. Coca-Cola reduces the size and softens the make-up of the bezoar, and combined with other treatments, enhances the dissolution.

History

A phytobezoar was first successfully treated with Coca-Cola lavage in 2002.

References

{{Digestive system diseases, state=collapsed Stomach disorders Medical treatments Gastrointestinal tract disorders Carbonated drinks