Gastric emptying and bezoars in Japanese

Abstract

Bezoars are conglomerates of undigested material in the stomach. Previous reports have shown that a decrease in secretion of pepsin and gastric acid and a delay in gastric emptying might contribute to their formation. To clarify the pathogenesis of the formation of gastric bezoars, we studied gastric emptying in five patients who presented with a bezoar. In addition, gastric acid secretion was studied in three of the cases. Gastric emptying was not delayed in any case, and there was no trend toward a decrease in gastric acid secretion. The five patients were successfully treated by the endoscopic fragmentation and enzymatic dissolution of the bezoars. We conclude that, in Japanese, factors other than a delay in gastric emptying are the main contributors to bezoar formation.

Clinical Characteristics and Treatment Outcomes of Nineteen Japanese Patients with Gastrointestinal Bezoars

“…Although several bezoar case series have been reported from Western countries (3)(4)(5)(6) and South Korea (7), only single case reports or small case series describing a few Japanese patients are available, to our knowledge (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In Japan, the epidemiology and etiology of bezoars have not been fully elucidated, and treatment is empirical.…”

Endoscopic Gastric Food Retention in Relation to Scintigraphic Gastric Emptying Delays and Clinical Factors

“…Bezoars are solid, organized masses of indigestible material and are comprised of undigested food (phytobezoar), hair (trichobezoar), medications (pharmacobezoars), or persimmons (diospyrobezoar). Phytobezoars most commonly present as complications of gastric surgery [7][8][9][10][11][12]. In most cases, the small, medium, and large amounts of retained food reported in this study were poorly organized and did not exhibit a mass-like consistency.…”

“…Findings from this study show a close association of retained gastric food residue to delays in gastric emptying. This relationship has not always been observed in the [7,16]. However, these older studies had smaller sample sizes and used non-standardized methods to quantify emptying delays.…”

“…As many cases occur after gastric surgery with vagotomy suggests an important role for delayed gastric emptying, but attempts to attribute bezoar formation to impaired motor function have yielded conflicting results. Older studies reported normal gastric emptying in postsurgical patients with versus without bezoars, using non-standardized scintigraphic and nonscintigraphic methods (e.g., acetaminophen absorption) [7,16]. However, others noted delayed emptying in postsurgical and non-operated patients with bezoars using fluoroscopic and other techniques [9,11].…”

“…A subset of patients with food retention exhibit phytobezoars, organized masses of predominantly vegetable residue; however, this finding is rare in most large series [6]. Most phytobezoars have been reported in older studies in association with surgery for peptic ulcer disease, usually with performance of vagotomy [7][8][9][10][11][12]. Other less common causes of bezoars include diabetes and neuromuscular diseases such as myotonic dystrophy [6,[13][14][15].…”