Carbonated soda treatment of phytobezoars

Carbonated soda treatment of phytobezoars is the use of carbonated soda to try to dissolve a phytobezoar. Bezoars consist of a solid and formed mass trapped in the gastrointestinal system, usually in the stomach.[1][2][3] These can also form in other locations.[4][5]

Phytobezoar
ICD-9-CM938
MeSHD001630
MedlinePlus001582

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 dissolution. Unfortunately, this treatment can result in the potential of developing small bowel obstruction in a minority of cases, necessitating surgical intervention.[1] It is one of many other stomach disorders that can have similar symptoms.

Gastric phytobezoars are a form of intestinal 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, tannins, celery, pumpkin skin, grape skins, prunes, raisins, vegetables and fruits.[1] Phytobezoars can form after eating persimmons and pineapples. These are more difficult to treat and are referred to as diospyrobezoars.[6]

Treatment
Other medicinal claims for Coca-Cola

Carbonated soda may help to dissolve phytobezoars.[7] It can be given by a naso-gastric tube in children.[8] Carbonated soda can also be given by mouth and during endoscopy.[9] It is effective in about half of the cases.[7]

It promotes dissolution by endoscopic techniques in the majority of the patients left, leading to a final success rate up to 91.3%.[6] In some cases, regular use of Coca-Cola resulted in no recurrence 3–15 months after the first episode.[6] Treatment has varied widely. Coca-Cola has been administered 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.[6] 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.[1]

Contraindications

Trichobezoars do not respond to treatment with Coca-Cola but instead this type may have to be surgically removed.[9] 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.[1][6]

Adverse effects and interactions

Adverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation.[6] 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, meat tenderizer has been used to dissolve bezoars of the stomach.[10][11] When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%.[6] The mechanism by which Coca-Cola dissolves the bezoar is based upon its low pH, CO2 bubbles, and sodium bicarbonate content.[9]

"...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 will do the trick, assuming it does not cause dysPEPSIa."[10]

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.[12] Coca-Cola has a pH of 2.6. This is due to carbonic and phosphoric acid 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.[6]

History

A phytobezoar was first successfully treated with Coca-Cola lavage in 2002.[1]

References
  1. Iwamuro M.; Okada H.; Matsueda K.; Inaba T.; Kusumoto C.; Imagawa A.; Yamamoto K. (2015). "Review of the diagnosis and management of gastrointestinal bezoars". World Journal of Gastrointestinal Endoscopy. 7 (4): 336–345. doi:10.4253/wjge.v7.i4.336. PMC 4400622. PMID 25901212.
  2. "bezoar" at Dorland's Medical Dictionary
  3. DiMarino, Anthony (2002). Gastrointestinal disease : an endoscopic approach. Thorofare, NJ: Slack. p. 551. ISBN 978-1556425110.
  4. Bala M, Appelbaum L, Almogy G (November 2008). "Unexpected cause of large bowel obstruction: colonic bezoar". Isr. Med. Assoc. J. 10 (11): 829–30. PMID 19070299.
  5. Pitiakoudis M, Tsaroucha A, Mimidis K, et al. (June 2003). "Esophageal and small bowel obstruction by occupational bezoar: report of a case". BMC Gastroenterol. 3 (1): 13. doi:10.1186/1471-230X-3-13. PMC 165420. PMID 12795814.
  6. Ladas, S. D.; Kamberoglou, D.; Karamanolis, G.; Vlachogiannakos, J.; Zouboulis-Vafiadis, I. (2013). "Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment". Alimentary Pharmacology & Therapeutics. 37 (2): 169–173. doi:10.1111/apt.12141. ISSN 0269-2813. PMID 23252775.
  7. Feldman, Mark (2016). Sleisenger and Fordtran's gastrointestinal and liver disease : pathophysiology/diagnosis/management. Philadelphia, PA: Elsevier/Saunders. p. 435. ISBN 978-1455746927. Carbonated soda (e.g., Coca Cola) may be effective in the dissolution of over 50% of cases of phytobezoars and over 90% when combined with endoscopic methods.
  8. Wyllie, R (2011). Pediatric gastrointestinal and liver disease. Philadelphia: Elsevier Saunders. ISBN 978-1437735666.
  9. Elzouki, Abdelaziz (2012). Textbook of clinical pediatrics. Berlin: Springer. p. 1796. ISBN 978-3642022029.
  10. Stockman, James (2011). Year book of pediatrics. St. Louis, Mo: Elsevier Mosby. ISBN 978-0323087469.
  11. Norton, Jeffrey (2008). Surgery basic science and clinical evidence. New York, NY: Springer. p. 868. ISBN 9780387308005.
  12. LastName, FirstName (2015). Clinical cases and pearls in medicine. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. ISBN 978-9351526469.
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