| 词条 | Carbonated soda treatment of phytobezoars |
| 释义 |
| Name = Phytobezoar | Image = | Caption = | DiseasesDB = 30758 | ICD10 = | ICD9 = {{ICD9|938}} | ICDO = | OMIM = | MedlinePlus = 001582 | eMedicineSubj = | eMedicineTopic = |MeshID = D001630 }}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] 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.[6] 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.[9] TreatmentCarbonated 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%.[10] In some cases, regular use of Coca-Cola resulted in no recurrence 3–15 months after the first episode.[10] Treatment has varied widely. Coca-Cola has been administrated 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.[10] Alternative treatments are the use of cellulase, acetylcysteine, papain, pancreatic enzymes, saline solution, 0.1 N HCl and sodium bicarbonate. with papain such as gastric ulcer, hyponatremia and oesophageal perforation. 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] ContraindicationsTrichobezoars 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][10]Adverse effects and interactionsAdverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation.[10] 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 interactionsIn addition to Coca-Cola, meat tenderizer has been used to dissolve bezoars of the stomach.[11][12] When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%.[10] 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."[11] 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.[13] 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.[10] HistoryA phytobezoar was first successfully treated with Coca-Cola lavage in 2002.[1] References1. ^1 2 3 4 5 {{cite journal |author1=Iwamuro M. |author2=Okada H. |author3=Matsueda K. |author4=Inaba T. |author5=Kusumoto C. |author6=Imagawa A. |author7=Yamamoto K. | year = 2015 | title = Review of the diagnosis and management of gastrointestinal bezoars | journal = World Journal of Gastrointestinal Endoscopy | volume = 7 | issue = 4| pages = 336–345 | doi = 10.4253/wjge.v7.i4.336 | pmid = 25901212 | pmc=4400622}} {{Digestive system diseases|state=collapsed}}2. ^{{DorlandsDict|one/000012475|bezoar}} 3. ^{{cite book | last = DiMarino | first = Anthony | title = Gastrointestinal disease : an endoscopic approach | publisher = Slack | location = Thorofare, NJ | year = 2002|page=551 | isbn = 978-1556425110 }} 4. ^{{cite journal |vauthors=Bala M, Appelbaum L, Almogy G |title=Unexpected cause of large bowel obstruction: colonic bezoar |journal=Isr. Med. Assoc. J. |volume=10 |issue=11 |pages=829–30 |date=November 2008 |pmid=19070299 |doi= |url=}} 5. ^{{cite journal |vauthors=Pitiakoudis M, Tsaroucha A, Mimidis K |title=Esophageal and small bowel obstruction by occupational bezoar: report of a case |journal=BMC Gastroenterol |volume=3|page=13 |date=June 2003 |pmid=12795814 |pmc=165420 |doi=10.1186/1471-230X-3-13 |url=http://www.biomedcentral.com/1471-230X/3/13 |issue=1|display-authors=etal}} 6. ^{{cite web | title = Stomach, Definition and Patient Education |publisher=Healthline| url = http://www.healthline.com/health/stomach#Overview1 | accessdate = 2015-07-10 }} 7. ^1 {{cite book | last = Feldman | first = Mark | title = Sleisenger and Fordtran's gastrointestinal and liver disease : pathophysiology/diagnosis/management | publisher = Elsevier/Saunders | location = Philadelphia, PA | page=435|year = 2016 | isbn = 978-1455746927 |quote=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. ^{{cite book | last = Wyllie | first = R | title = Pediatric gastrointestinal and liver disease | publisher = Elsevier Saunders | location = Philadelphia | year = 2011 | isbn = 978-1437735666 }} 9. ^1 2 {{cite book | last = Elzouki | first = Abdelaziz | title = Textbook of clinical pediatrics | publisher = Springer | location = Berlin | year = 2012 |page=1796| isbn = 978-3642022029 }} 10. ^1 2 3 4 5 6 7 {{cite journal|last1=Ladas|first1=S. D.|last2=Kamberoglou|first2=D.|last3=Karamanolis|first3=G.|last4=Vlachogiannakos|first4=J.|last5=Zouboulis-Vafiadis|first5=I.|title=Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment|journal=Alimentary Pharmacology & Therapeutics|volume=37|issue=2|year=2013|pages=169–173|issn=0269-2813|doi=10.1111/apt.12141|pmid=23252775}} 11. ^1 {{cite book | last = Stockman | first = James | title = Year book of pediatrics | publisher = Elsevier Mosby | location = St. Louis, Mo | year = 2011 | isbn = 978-0323087469 }} 12. ^{{cite book | last = Norton | first = Jeffrey | title = Surgery basic science and clinical evidence | publisher = Springer | location = New York, NY |page=868| year = 2008 | isbn = 9780387308005 }} 13. ^{{cite book | last = LastName | first = FirstName | title = Clinical cases and pearls in medicine | publisher = Jaypee Brothers Medical Publishers (P) Ltd | location = New Delhi | year = 2015 | isbn = 978-9351526469 }} 9 : Stomach disorders|Medical treatments|Gastrointestinal tract disorders|Coca-Cola|Drink brands|American drinks|Cola brands|Coca-Cola brands|Patent medicines |
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