Esophageal obstruction caused by Cal-Ban

Morse, John M. D.; Malloy, William X.

doi:10.1016/0016-5085(90)90314-q

Cited by 8 publications

(8 citation statements)

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“…a noncellulose polysaccharide found in over-the-counter 'diet-pill' prepara tions. has been reported to cause esophageal and small bowel obstruction [25,26]. Preex isting esophageal or gastric disorders were present in 50% of those with esophageal ob struction, while none of those with small bow el obstruction had any underlying predispos ing disorder.…”

Section: Guar Gum Bezoarmentioning

confidence: 96%

Pharmacobezoar: An Evolving New Entity

Stack

Thomas²

1995

Dig Dis

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Pharmacobezoars, bezoars comprised of medications, are unusual entities. Medications reported to cause bezoars include aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate. They most often occur, as do bezoars of any type, in a background of altered motility or anatomy of the gastrointestinal tract. Bowel hypoactivity, dehydration, and concomitant use of anticholinergics and narcotis appear to contribute to the propensity for bezoar formation by aluminum hydroxide gel and Isocal. The hygroscopic properties of psyllium and guar gum appear to contribute to their propensity to form bezoars. Insolubility of the carrying vehicle of enteric-coated aspirin and nifedipine is the setting in which these medications form bezoars. In contrast to nonmedication bezoars, pharmacobezoars may produce additional symptoms, those related to the release of their active ingredients. In patients with suspected gastrointestinal tract emptying problems, whether esophageal, gastric, small bowel, or colonic, the astute clinician should consider pharmacobezoar in the differential diagnosis.

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Section: Guar Gum Bezoarmentioning

confidence: 96%

Pharmacobezoar: An Evolving New Entity

Stack

Thomas²

1995

Dig Dis

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“…The Panel noted that these restrictions have to be seen against the background of human cases on severe adverse effects, such as oesophageal obstruction or asphyxiation, after oral intake of other gums/hydrocolloids with similar physicochemical properties as locust bean gum in the form of granules or pills without enough liquid (e.g. guar gum: Ranft and Imhof, 1983;Morse and Malloy, 1990;Opper et al, 1990;Seidner et al, 1990;Lewis, 1992;Halama and Mauldin, 1992;Taylor et al, 1998;FDA, 2015) or in the form of jelly minicups (konjac gum/glucomannan: EFSA, 2004).…”

Section: Authorised Uses and Use Levelsmentioning

confidence: 99%

Re‐evaluation of locust bean gum (E 410) as a food additive

Mortensen¹,

Aguilar²,

Crebelli³

et al. 2017

EFS2

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Following a request from European Commission, the EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS) provides a scientific opinion re-evaluating the safety of locust bean gum (E 410) as a food additive. Locust bean gum (E 410) is an authorised food additive in the EU. Locust bean gum (E 410) as specified in the Commission Regulation (EU) No 231/2012 is derived from the ground endosperm of the seeds of the strains of carob tree, Ceratonia siliqua (L.) Taub. (Family Leguminosae). An acceptable daily intake (ADI) 'not specified' was allocated by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA) in 1981. Although not evaluated by the Scientific Committee for Food (SCF), it was accepted by the SCF in 1991 for use in weaning food, and in 1994, in infant formulae for special medical purposes. Locust bean gum is practically undigested, not absorbed intact, but significantly fermented by enteric bacteria in humans. No adverse effects were reported in 90-day toxicity and carcinogenicity studies in rodents at the highest doses tested and there was no concern with respect to the genotoxicity and to reproductive and developmental toxicity of locust bean gum (E 410). The Panel concluded that there is no need for a numerical ADI for locust bean gum (E 410), and that there is no safety concern for the general population at the refined exposure assessment for its reported uses as a food additive. However, infants and young children consuming foods for special medical purposes may show a higher susceptibility to gastrointestinal effects of locust bean gum due to their underlying medical condition. The Panel concluded that the available data do not allow an adequate assessment of the safety of locust bean gum (E 410) in these foods for infants and young children.

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“…The most well known hygroscopic medications implicated in esophageal obstruction are guar gum, psyllium, and glucomannan (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12). Their hygroscopic properties, the ability to swell rapidly when exposed to water, have made them an ideal agent for weight loss products.…”

Section: Discussionmentioning

confidence: 99%

“…Both substances have been used to control diabetes, help with weight loss, and reduce cholesterol (3). Both substances have also been implicated as the causative agent in cases of esophageal and intestinal obstruction, in patients taking tablets containing them (1,2,(4)(5)(6)(7)(8). In May 1985, marketing of tablets containing glucomannan was prohibited under the consumer product safety provisions of the Trade Practices Act in the country of Australia.…”

Section: Introductionmentioning

confidence: 97%

Esophageal obstruction from a hygroscopic pharmacobezoar containing glucomannan

Vanderbeek¹,

Fasano²,

O’Malley³

et al. 2007

Clinical Toxicology

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Glucomannan is a dietary fiber that is the main polysaccharide obtained from the tubers of the Amorphophallus konjac plant. It has been used as a dietary fiber for more than 1,000 years in eastern cultures, and has gained popularity in many western countries over the last 20 years. This soluble fiber has very substantial water-holding properties, and forms highly viscous solutions when dissolved in water. It also has considerable hygroscopic properties, expanding rapidly to many times the size of the original material. These properties have made glucomannan an ideal diet agent as the material swells in the GI tract after ingestion, producing a feeling of satiety and fullness. It has also been reported to have hypocholesterolemic, hypoglycemic, hypoinsulinemic and anti-constipatory effects. The negative effects reported include flatulence, abdominal pain, gastrointestinal obstruction, and possible modification of the bioavailability of other medications. This report describes a 37-year-old female who developed delayed esophageal obstruction after ingesting an over-the-counter diet aid containing glucomannan. The patient ultimately cleared the obstruction through forceful emesis, just prior to upper gastrointestinal endoscopy. The patient was noted to have an esophageal web during outpatient endoscopy. This case illustrates the potential dangers of glucomannan and other hygroscopic medications in patients with a history of upper gastrointestinal pathology.

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Esophageal obstruction caused by Cal-Ban

Cited by 8 publications

References 0 publications

Pharmacobezoar: An Evolving New Entity

Pharmacobezoar: An Evolving New Entity

Re‐evaluation of locust bean gum (E 410) as a food additive

Esophageal obstruction from a hygroscopic pharmacobezoar containing glucomannan

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