A bezoar is a mass often found 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 ...

, though it can occur in other locations. A pseudobezoar is an indigestible object introduced intentionally into the digestive system. There are several varieties of bezoar, some of which have

inorganic In chemistry, an inorganic compound is typically a chemical compound that lacks carbon–hydrogen bonds, that is, a compound that is not an organic compound. The study of inorganic compounds is a subfield of chemistry known as '' inorganic chemist ...

constituents and others organic. The term has both a modern (medical, scientific) and traditional usage.

Types

By content

* Food boluses (or boli; singular bolus) have the archaic and positive meaning of bezoar, and are composed of loose aggregates of food items such as seeds, fruit pith, or pits, as well as other types of items such as

shellac Shellac () is a resin secreted by the female lac bug on trees in the forests of India and Thailand. It is processed and sold as dry flakes and dissolved in alcohol to make liquid shellac, which is used as a brush-on colorant, food glaze and ...

bubble gum Bubble gum or bubblegum is a type of chewing gum, designed to be inflated out of the mouth as a bubble. Bubble gum flavor While there is a bubble gum "flavor" – which various artificial flavorings including esters are mixed to obtain – it ...

, soil, and concretions of some medications. * Lactobezoars are a specific type of food bezoar comprising

inspissated Inspissation is the process of thickening by dehydration. Intentional use Inspissation is the process used when heating high-protein containing media; for example to enable recovery of bacteria for testing. Once inspissation has occurred, any stain ...

milk. It is most commonly seen in premature infants receiving formula foods. * Pharmacobezoars (or medication bezoars) are mostly tablets or semiliquid masses of drugs, normally found following

overdose A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.

of sustained-release medications. *

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 ...

s are composed of indigestible plant material (e.g.,

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 wall ...

), and are frequently reported in patients with impaired digestion and decreased gastric motility. * Diospyrobezoar is a type of phytobezoar formed from unripe

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-pers ...

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 Atlanta ...

has been used to treat them. *

Trichobezoar A hairball is a small collection of hair or fur formed in the stomach of animals, and uncommonly in humans, that is occasionally vomited up when it becomes too big. Hairballs are primarily a tight elongated cylinder of packed fur, but may inclu ...

is a bezoar formed from hair – an extreme form of

hairball A hairball is a small collection of hair or fur formed in the stomach of animals, and uncommonly in humans, that is occasionally vomited up when it becomes too big. Hairballs are primarily a tight elongated cylinder of packed fur, but may includ ...

. Humans who frequently consume hair sometimes require these to be removed. In cases of

Rapunzel syndrome Rapunzel syndrome is an extremely rare intestinal condition in humans resulting from ingesting hair (trichophagia). The syndrome is named after the long-haired girl Rapunzel in the fairy tale by the Brothers Grimm. Trichophagia is sometimes assoc ...

, surgery may be required.

By location

* A bezoar in the

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...

is common in young children and in

horse The horse (''Equus ferus caballus'') is a domesticated, one-toed, hoofed mammal. It belongs to the taxonomic family Equidae and is one of two extant subspecies of ''Equus ferus''. The horse has evolved over the past 45 to 55 million y ...

s; in horses, it is known as choke. * A bezoar in the

large intestine The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being r ...

is known as a

fecalith A fecalith is a stone made of feces. It is a hardening of feces into lumps of varying size and may occur anywhere in the intestinal tract but is typically found in the colon. It is also called appendicolith when it occurs in the appendix and is ...

. * A bezoar in the

trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...

is called a tracheobezoar.

Cause

Esophageal bezoars discovered in nasogastrically fed patients on mechanical ventilation and sedation are reported to be due to precipitation of certain food types rich in casein, which are precipitated with gastric acid reflux to form esophageal bezoars. Bezoars can also be caused by

gastroparesis Gastroparesis (gastro- from Ancient Greek γαστήρ – gaster, "stomach"; and -paresis, πάρεσις – "partial paralysis"), also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions (peristalsis) ...

due to the slowing of gastric emptying, which allows food to form a bolus.

History

The word ''bezoar'' is derived from the

Persian Persian may refer to: * People and things from Iran, historically called ''Persia'' in the English language ** Persians, the majority ethnic group in Iran, not to be conflated with the Iranic peoples ** Persian language, an Iranian language of the ...

(), literally "antidote". The myth of the bezoar as an antidote was introduced to Europe from the Middle East in the 11th century and remained popular until the 18th century. It was believed to have the power of a universal

antidote An antidote is a substance that can counteract a form of poisoning. The term ultimately derives from the Greek term φάρμακον ἀντίδοτον ''(pharmakon) antidoton'', "(medicine) given as a remedy". Antidotes for anticoagulants are s ...

, would work against any

poison Poison is a chemical substance that has a detrimental effect to life. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broa ...

, and that a drinking glass which contained a bezoar could neutralize any poison poured into it. Ox bezoars are used in

Chinese herbology Chinese herbology () is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine (TCM). A ''Nature'' editorial described TCM as "fraught with pseudoscience", and said that t ...

, also known as () or ''

calculus bovis ''Calculus bovis'', ''niu-huang'' (牛黃) or ox bezoars are dried gallstones of cattle used in Chinese herbology. In China and Japan it has been long used to treat various diseases, including high fever, convulsion and stroke. In Asian countries, ...

.'' They are gallstones or gallstone substitutes created from ox or cattle bile. In some products, they claim to remove toxins from the body. The Andalusian physician

Ibn Zuhr Abū Marwān ‘Abd al-Malik ibn Zuhr ( ar, أبو مروان عبد الملك بن زهر), traditionally known by his Latinized name Avenzoar (; 1094–1162), was an Arab physician, surgeon, and poet. He was born at Seville in medieval And ...

( 1161), known in the West as Avenzoar, is thought to have made the earliest description of bezoar stones as medicinal items. Extensive reference to bezoars also appears in the ''

Picatrix ''Picatrix'' is the Latin name used today for a 400-page book of magic and astrology originally written in Arabic under the title ''Ghāyat al-Ḥakīm'' ( ar, غاية الحكيم), which most scholars assume was originally written in the midd ...

''. In 1567, French surgeon

Ambroise Paré Ambroise Paré (c. 1510 – 20 December 1590) was a French barber surgeon who served in that role for kings Henry II, Francis II, Charles IX and Henry III. He is considered one of the fathers of surgery and modern forensic pathology and a p ...

did not believe that it was possible for the bezoar to cure the effects of any poison, and described an experiment to test the properties of the stone. A cook in the King's court was sentenced to death, and chose to be poisoned. Paré administered the bezoar stone to the cook, but it had no effect, and the cook died in agony seven hours after taking the poison, proving that contrary to popular belief, the bezoar could not cure all poisons. Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew A. Benson of the

Scripps Institution of Oceanography The Scripps Institution of Oceanography (sometimes referred to as SIO, Scripps Oceanography, or Scripps) in San Diego, California, US founded in 1903, is one of the oldest and largest centers for oceanography, ocean and Earth science research ...

show that when bezoars are immersed in an arsenic-laced solution, they can remove the poison. The toxic compounds in arsenic are

arsenate The arsenate ion is . An arsenate (compound) is any compound that contains this ion. Arsenates are salts or esters of arsenic acid. The arsenic atom in arsenate has a valency of 5 and is also known as pentavalent arsenic or As(V). Arsenate res ...

and

arsenite In chemistry, an arsenite is a chemical compound containing an arsenic oxyanion where arsenic has oxidation state +3. Note that in fields that commonly deal with groundwater chemistry, arsenite is used generically to identify soluble AsIII anions. ...

; each is acted upon differently by the bezoars: arsenate is removed by being exchanged for phosphate in

brushite Brushite is a phosphate mineral with the chemical formula . Crystals of the pure compound belong to the monoclinic space group C2/c and are colorless.common law In law, common law (also known as judicial precedent, judge-made law, or case law) is the body of law created by judges and similar quasi-judicial tribunals by virtue of being stated in written opinions."The common law is not a brooding omnipresen ...

England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...

('' Chandelor v Lopus'', 79 Eng Rep. 3, Cro. Jac. 4, Eng. Ct. Exch. 1603) announced the rule of ("let the buyer beware") if the goods they purchased are not in fact genuine and effective. The case concerned a purchaser who sued for the return of the purchase price of an allegedly

fraud In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law (e.g., a fraud victim may sue the fraud perpetrator to avoid the fraud or recover monetary compens ...

ulent bezoar. Bezoars were important objects in cabinets of curiosity and natural history collections, mainly for their use in early modern pharmacy and the study of animal health. The ''

Merck Manual of Diagnosis and Therapy ''The Merck Manual of Diagnosis and Therapy'', referred to as ''The Merck Manual'', is the world's best-selling medical textbook, and the oldest continuously published English language medical textbook. First published in 1899, the current print e ...

'' notes that consumption of unripened

s has been identified as the main cause of epidemics of intestinal bezoars, and that up to 90 percent of bezoars that occur from excessive consumption require surgery for removal. A 2013 review of three databases identified 24 publications presenting 46 patients treated with

for phytobezoars. The cola was administered in doses of to up to over 24 hours, orally or by gastric lavage. A total of 91.3% of patients had complete resolution after treatment with Coca-Cola: 50% after a single treatment, with others requiring the cola plus endoscopic removal. Doctors resorted to surgical removal in four cases.

References

Bibliography

* Barry Levine. 1999. ''Principles of Forensic Toxicology''. Amer. Assoc. for Clinical Chemistry. . * Martín-Gil FJ, Blanco-Ávarez JI, Barrio-Arredondo MT, Ramos-Sanchez MC, Martin-Gil J. ''Jejunal bezoar caused by a piece of apple peel'' – Presse Med, 1995 Feb. 11; 24(6):326. * * This article incorporates text from a publication now in the

public domain The public domain (PD) consists of all the creative work A creative work is a manifestation of creative effort including fine artwork (sculpture, paintings, drawing, sketching, performance art), dance, writing (literature), filmmaking, ...

External links

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