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Bezoars, Phytobezoars and Diospyrobezoars, OH MY!!!
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IMPORTANT NOTE:  What follows is in no way medical advice.  It is included in these pages on persimmons simply because of the rare occurence of bezoars and the association with people with compromised gastrointestinal systems.  You should not take this as any sort of medical recommendation on which to act.  As with any health issue, you should seek the advice of your physician if you are experiencing any abnormal symptoms, or before making any decisions related to your health.

Bezoars

Bezoars are extraordinary, and border on the bizarre.  A bezoar is a concretion of indigestible plant and/or animal material that remains in the gastrointestinal tract of animals.  Over time, they associate with mucous and form masses.  They are usually found in the stomach but can be found anywhere between the esophagus to the rectum (Altinli et al. 2004, Sanders 2004).

The term bezoar is thought to be derived from the Arabic, Persian, or Turkish words referring to antidote or counter-poison. 

As early as 1000 BCE bezoars from animals were highly prized and kept as medical charms, used as antedotes to various poisons, used as treatment in ailments, and held to ward off the supernatural.  European nobles had bezoars set into chains or interior as part of "poison-cups" that were believed to render poisons harmless.  These beliefs held for centuries.  They were also commonly set into jewelry as "bezoar stones".  A bezoar with a gold frame was known to be in the Crown Jewels of
Queen Elizabeth I in 1962 (Andrus 1988, Lonicer 1577, Maingot 1985, Sanders 2004, Sleisenger 1983, and others).

The market for bezoars thrives to this day.  Unfortunately, they are in high demand by practitioners of asian medicine.  The demand has created and sustained a thriving market for poachers and indiscriminant killers of various animals. 

Bezoars may be composed of a variety of items including plant material (phytobezoars), hair (trichobezoars), milk & milk products (lactobezoars), medication, or animal products (MUSCDDC 2002, Sanders 2004).


Phytobezoars

Phytobezoars are concretions of plant origin.  Among the possible plant sources of components known to be able to form bezoars are apples, berries, brussel sprouts, celery, coconuts, figs, grapes, green beans, legumes, oranges, persimmons, potatoes, and sauerkraut (Sanders 2004).


Diospyrobezoars

Diospyrobezoars are rarely occuring phytobezoars associated with the excessive eating of persimmons.  Diospyrobezoars are often very hard and almost woody in consistency.  One case in medical literature from 2004 revealed a 51-year old patient who had eaten a kilogram (2.2 pounds) of unpeeled persimmons each day for 40 years (Altinli et al. 2004)!

While a number of ailments may produce the same symptoms, the symptoms created by diospyrobezoars may include distended and tender stomach, dyspepsia (pain or discomfort in the area between the belly-button and the sternum), bloating, vomiting,  weakness, and weight loss (Sanders 2004).


Those at Risk

People predisposed to bezoars include those who have had previous gastric surgery, slowed gastric motility, Cystic Fibrosis, Diabetes melliuts, Guillian Barre, hypothyroidism, Intrahepatic cholestasis, Miltonic Dystrophy, and Renal failure, as well as some Psychiatric illnesses (Kishan 2001, Sanders 2004).


Treatment

Bezoars may often be treated with medical therapy to dissolve the bezoar with enzymes.  Oddly enough, one such therapy even uses Coca Cola (Chung et al 2005)!  Endoscopic procedures are primarily used with bezoars.  However, in severe cases, or with very large bezoars, surgery may be required.  Laparoscopy has been used successfully in several such surgeries (
Altinli 2004, Andrus 1988, Maingot 1985, Sanders 2004, and others).

REFERENCES:


Altinli, E., K. Saribeyoglu, and C. Uras.  2004.  Laparoscopic extirpation of a large gastric diospyrobezoar.  Case Rep Clin Pract Rev, 5: 503–505

Andrus, C.H. 1988.  American Journal of Gastroenterology, 83(5): 476-8.

Chung, Y.W. et al.  2005.  Huge Gastric Diospyrobezoars Successfully Treated By Oral Intake And Endoscopic Injection of Coca-Cola.  Digestive And Liver Disease, 38(7): 515-517.

Kishan, A. , N.K. Kadli, B.G. Ponnappa, M. Paul Korath, and K. Jagadeesan. 2001.  Bezoars.  Bombay Hospital Journal, 43(4):

Lonicer, Adam.  1577
.  Kreuterbuch: Künstliche Conterfeytunge der Bäume, Stauden, Hecken, Kreuter, Getreyde, Gewürtze...
Adam Lonicer.  Published by Christian Egenolff, Frankfurt, Germany.

Maingot, Rodney.  1985.  Maingot's Textbook of Abdominal Surgery, 8th edition. Appelton Century Crofts, Norwalk Connecticut. pp. 675-81.

Medical University of South Carolina Digestive Disease Center
(MUSCDDC) . 2002.  Case Studies 40 (Stomach): Gastric Bezoars. [Internet]. Charleston, SC:  [cited 2008 Mar 2]. Available from http://www.ddc.musc.edu/ddc_pro/pro_development/case_studies/case040.htm

Sanders, Michael K.  2004.  Bezoars: From Mystical Charms to Medical and Nutritional Management.  Practical Gasteroenterology, January: 37-50.

Sleisenger, Marvin H. et al. 1983.  Gastrointestinal Disease Pathophysiology, Diagnosis, and Management. Third edition. WB Saunders Company, Philidelphia, USA. pp. 608-12.