The Relationship between Acid-Suppressing Drugs and Phytobezoar Formation: A Retrospective Analysis and Discussion of Phytobezoar Formation

Abstract

Objectives: Although phytobezoars are a rare cause of gastrointestinal obstruction, they are most commonly found in patients with previous gastric surgery. It is well known that predisposing factors of phytobezoar formation are ingestion of fruits containing soluble tannin, presence of dilute hydrochloric acid in the stomach, and gastric stasis or delayed emptying. We investigated whether intake of acid-suppressing drugs that neutralize gastric acidity or inhibit gastric acid secretion to constitute a hypo-acidic condition, increases the risk of phytobezoar formation. Materials and methods: Between September 1992 and October 2008, 32 patients (24 male and 8 female) with gastrointestinal phytobezoars were diagnosed either surgically or endoscopically at the Tri-Service General Hospital, Taipei, Republic of China. The data were collected from hospital records and analyzed retrospectively. Results: Eighteen (56.25%) of all patients had previous gastric surgery and 6 (42.9%) of the 14 patients who had not undergone surgery had diabetes mellitus. The majority of admissions were during winter and spring (between October and March) (P < 0.01) and none of the patients had taken acid-suppressing drugs during the 6 months before detection of gastrointestinal phytobezoars.

Conclusions: In our study, intake of acid-suppressing drugs did not increase the risk of phytobezoar formation in patients with normal gastric motility. Moreover, we believe that the major factor in phytobezoar formation is gastric stasis or delayed emptying, which sufficiently prolongs the retention period of materials in the stomach, while dilute hydrochloric acid is a minor factor.

Key Words:

• Phytobezoar
• acid-suppressing drugs
• previous gastric surgery
• dilute hydrochloric acid.

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Notes on contributors

D.-C. Chan

Dr. D.-C. Chan Division of General Surgery Department of Surgery Tri-Service General Hospital, No.325 Cheng-Kung Road, Sec. 2, Neihu 114, Taipei Taiwan, Republic of China Tel.: [phone] Fax: [phone] E-mail: [email protected]

J.-C. Yu

Dr. J.-C. Yu Division of General Surgery Department of Surgery Tri-Service General Hospital, No. 325 Cheng-Kung Road, Sec. 2, Neihu 114, Taipei Taiwan, Republic of China Tel.: [phone] Fax: [phone] E-mail: [email protected]