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The oesophagus.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Polyps - of fibrovascular, lipomatous or hamartomatous types - may be found in the oesophagus. As they tend to hang from a stalk, they often move up and down with swallowing, and also keep the oesophagus locally distended. A long stalk may allow a polyp to be vomited up into the pharynx and mouth, or even be inhaled with respiratory obstruction. Illus. OES-POLYP. Bezoars and foreign bodies - some of these may mimic benign tumours. Radio-opaque masses may be seen on plain radiographs, but non-opaque ones may not always be suspected unless there is dysphagia or signs suggesting perforation. These may include swallowed dentures which are often non-opaque, or impacted food masses above a stricture (piece of meat, raw carrot, etc.) - Illus. OES-FOREIGN BODY.
Palliative Care of Gastroparesis
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Patients with GP may experience secondary gastrointestinal disorders, which include gastroesophageal reflux disease (GERD), gastric bezoars and small intestinal bacterial overgrowth (SIBO) (Hasler 2007). Patients with GP have an increased tendency to acid reflux due to impaired stomach contractility and prolonged retention of gastric contents. Furthermore, reflux is exacerbated due to increased gastric distension resulting in relaxation of the lower esophageal sphincter (LES) (Bharadwaj et al. 2016). Acid-suppressive treatment should be strongly considered in those patients. Another complication is the increased risk of developing gastric bezoars. The incidence of bezoar formation determined by barium study was around 6% in GP patients (Levin et al. 2008). Bezoar formation occurs due to the lack of antral-pyloric grinding mechanism and the absence of major motor complexes. Upper endoscopy is required to confirm a definitive diagnosis.
Management of Diabetic Gastroparesis
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Kenneth L. Koch, Khalil N. Bitar
Most patients with GP learn to alter their diets because they identify what foods increase or decrease their nausea. Others, however, continue to consume foods rich in fat and fiber. Patients are coached that fatty or fried foods delay gastric emptying and fibrous foods are the most difficult foods for a weak stomach to mill and empty. Patients with diabetic GP may not appreciate that salads with lettuce, carrots, and other fresh, fibrous vegetables are difficult foods for the stomach to mill and empty. These foods are standard ADA diet recommendations for diabetic patients with normal gastric emptying, but are very difficult foods for the diabetic patients with GP [11,32]. The fruits, vegetables, and beans are choices that require much more gastric work to empty (compared with other choices) and often evoke early satiety, prolonged fullness, and nausea and vomiting. Patients with GP may also form phytobezoars, masses of fibrous food that are retained in the fundus or corpus, because the weak stomach cannot empty these foods. Foods known to form bezoars include coconuts, berries, apples, sauerkraut, figs, legumes, oranges, and potato peels [33,34]. Thus, patients need to be advised that these and any fibrous, pulpy foods are to be avoided.
Trichobezoar presenting as an acute abdominal obstruction in a 17-year-old girl
Published in Paediatrics and International Child Health, 2022
Zuhal Bayramoglu, Rana Gunoz Comert, Basak Erginel, Abdulkadir Baziki
The word bezoar derives from the Arabic word ‘badzehr’ owing to the use of bezoars obtained from animals in ancient times as a remedy [1]. Bezoars are an accumulation of organic substances in the digestive tract. The common types of bezoar include trichobezoars which consist of hair and phytobezoars which consist of either vegetable or fruit fibres. Less commonly encountered bezoars are composed of anything swallowed which is indigestible [2]. Bezoars are often found in the stomach, and the pylorus creates a barrier which is difficult to cross in the digestive tract to move distally [1]. However, long hair sometimes reaches the small intestine which is called Rapunzel syndrome and has a clinical presentation that is not limited to the stomach and leads to small bowel obstruction [1].
A Gorilla Glue bezoar results in gastric outlet obstruction and gastrostomy
Published in Clinical Toxicology, 2021
Jonathan V. S. Wong, Travis D. Olives, Eric S. McGillis
As far as we are aware, this is the first reported case of a GG bezoar causing gastric outlet obstruction in a human. A small bowel obstruction from an accidental ingestion of GG was previously reported in a 71-year-old male, requiring surgical intervention to remove GG fragments from the stomach and jejunum [4]. When GG mixes with gastric acid it can expand greater than 8 times its volume within a 2-hour period post-ingestion via a polymerization reaction [5]. The resultant mass is firm, indigestible, and can obstruct the gastric outlet. Unlike cyanoacrylate glue ingestions, di-isocyanate ingestions do not adhere to the gastric mucosa [6]. Reported clinical signs in dogs and humans are anorexia, vomiting, hematemesis, lethargy, abdominal distension and pain which can be seen within hours of ingestion [2–4]. In veterinary literature, radiographs have been recommended as an initial screening test as they may detect the bezoar. If undetected, an abdominal CT can be considered for signs of gastrointestinal obstruction. Complication requiring surgical removal has been described in dogs ingesting as little as 2 ounces [2]. Not all ingestions of GG form obstructions, however gastrostomy or enterotomy should be considered in patients with persistent clinical signs of gastrointestinal obstruction confirmed by radiographic imaging.
Severe salicylate poisoning resistant to conventional management
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Divya Akshintala, Anjeanette Mendez, Ossama I. Ikladios, Vamsi Krishna Emani
In the case of the patient reported, we believe that the persistently elevated salicylate levels found were secondary to the formation of a pharmacobezoar. The dense opacity present in the stomach fundus on abdominal radiogram was likely a representation of the same (Figure 1). Bezoars lead to delayed absorption of aspirin and hence persistently elevated salicylate levels. Other clinical features of bezoars would include local symptoms of nausea, vomiting and gastrointestinal tract obstruction [5]. They often lead to the need for prolonged treatment and increase in morbidity. Our patient was on hemodialysis treatment for nearly 30 hours before we saw a decline in salicylate levels and clinical improvement. Our initial requests for endoscopy were unsuccessful which might have decreased the need for prolonged hemodialysis.