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Bezoar

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For the animal, see Bezoar ibex.
Bezoar stone
Bezoar stones were seen as valuable commodities, sometimes with magical healing properties, as in the early modern English case Chandelor v Lopus.[1]
Pronunciation
SpecialtyEmergency medicine Edit this on Wikidata

A bezoar stone (/ˈbizɔːr/, BEE-zor) is a mass often found trapped in the gastrointestinal system,[2] though it can occur in other locations.[3][4] A pseudobezoar is an indigestible object introduced intentionally into the digestive system.[5]

There are several varieties of bezoar, some of which have inorganic constituents and others organic. The term has both modern (medical, scientific) and traditional usage.

Types

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By content

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  • Food boluses (or boli; singular bolus) have the archaic and positive meaning of bezoar, and are composed of loose aggregates of food items such as seeds, fruit pith, or pits, as well as other types of items such as shellac, bubble gum, soil, and concretions of some medications.
  • Lactobezoars are a specific type of food bezoar consisting of inspissated milk. It is most commonly seen in premature infants receiving formula foods.
  • Pharmacobezoars (or medication bezoars) are mostly tablets or semiliquid masses of drugs, normally found following an overdose of sustained-release medications.[6]
  • Pseudobezoars are man-made ingestible, permeable, expandable implements that can swell in the stomach or in the intestines and stay inflated for a certain period of time, during which they perform particular functions, such as reducing gastric volume.[5]
  • Phytobezoars are composed of indigestible plant material (e.g., cellulose), and are frequently reported in patients with impaired digestion and decreased gastric motility.
  • Diospyrobezoar is a type of phytobezoar formed from unripe persimmons.[7] Coca-Cola has been used to treat them.[8][9][10]
  • Trichobezoar is a bezoar formed from hair[11] – an extreme form of hairball. Humans who frequently consume hair sometimes require these to be removed. In cases of Rapunzel syndrome, surgery may be required.
  • Ox bezoars (niu-huang (牛黃) or calculi bovis) are used in Chinese herbology[vague] to treat various diseases. They are gallstones or gallstone substitutes formed from ox or cattle bile. Some products allegedly remove toxins from the body.

By location

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Cause

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Esophageal bezoars discovered in nasogastrically fed patients on mechanical ventilation and sedation, are reported to be due to the precipitation of certain food types rich in casein, which are precipitated with gastric acid reflux to form esophageal bezoars. Bezoars can also be caused by gastroparesis and other systemic illnesses causing poor gastric motility, such as cystic fibrosis,[12] due to delayed or incomplete gastric emptying, which allows food to form a bolus.[13][12] Bezoars can also be caused or contributed to by poor mastication[12]

The bezoar is typical composed of poorly digestible materials such as plant fibres, casein, medications or hair.[12]

As such, bezoars can be common in individuals with trichophagia or pica.[14]

Pharmacobezoars (bezoars caused by medication ingestion) form due to the ingestion and accumulation, in the stomach, of poorly digestible materials such as slow-release medication coatings[15] or due to the pharmacological effects of ingested medications[12] such as salicylates[16] and often present with unique symptoms due to their contents[12]

A 2013 review of three databases identified 24 publications presenting 46 patients treated with Coca-Cola for phytobezoars. Clinicians administered the cola in doses of 500 ml (18 imp fl oz; 17 US fl oz) to up to 3,000 ml (110 imp fl oz; 100 US fl oz) over 24 hours, orally or by gastric lavage. A total of 91.3% of patients had complete resolution after treatment with Coca-Cola: 50% after a single treatment, with others requiring cola plus endoscopic removal. Doctors resorted to surgical removal in four cases.[17]

The Merck Manual of Diagnosis and Therapy notes that consumption of unripened persimmons has been identified as the main cause of epidemics of intestinal bezoars and that up to 90 percent of bezoars that occur from excessive consumption require surgery for removal.[18]

History

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The word bezoar is derived from the Persian pād-zahr (پادزهر), literally 'antidote'.[19] People believed that a bezoar had the power of a universal antidote and would work against any poison – a drinking glass that contained a bezoar could allegedly neutralize any poison poured into it. The myth of the bezoar as an antidote began in the Islamic world and India. Healers in these regions believed that bezoars had the ability to cure disease and overall protect the body, but most importantly, cure poison. Well-known Islamic physicians, such as Ibn Zuhr, played an important role in spreading this belief, where they describe bezoars as effective antidotes against poison.[20][21]

Ibn Zuhr (d. 1161), known in the West as Avenzoar, is thought[by whom?] to have made the earliest description of bezoar stones as medicinal items. Extensive reference to bezoars also appears in the Picatrix.

Through Arabic sources like medical texts and translation movements,[clarification needed] bezoars were introduced into Europe in the 12th century.[21] Later on, between the 16th and 17th centuries, bezoars became much more common across Europe due to the increase in global trade.[21] Bezoars, along with other valuables like jewels and diamonds, were brought from India and the East Indies. Bezoars from monkeys and the goats in the East Indies were considered to be the most valuable and most effective antidotes to poison.[21] During this time, bezoars were extremely popular due to new beliefs that the stone could also cure many other illnesses, such as plague, epilepsy, and melancholy, in addition to being a "cure-all" for poison.

Bezoars were important objects in Holy Roman Emperor Rudolf II's cabinets of curiosity[22] and in natural-history collections, mainly for their use in early-modern pharmacy and in the study of animal health. Since bezoars began as extremely rare objects, they were mainly found in royal or elite collections, where they were treated as prized possessions and symbols of wealth rather than medicinal. Elites kept bezoars in their possession not only for bodily protection, but also to represent their wealth and rank. For example, Queen Elizabeth I of England worn a bezoar ring.[21]

As bezoars were gaining more popularity in the 16th century, skepticism about their effectiveness increased. To prove the effectiveness of bezoars being able to cure poison, physicians conducted poison trials. In 1567, French surgeon Ambroise Paré did not believe that it was possible for the bezoar to cure the effects of any poison and described an experiment to test the properties of the stone. A cook in the King's court was sentenced to death and chose to be poisoned rather than hanged, under the condition that he would be given a bezoar after the poison. Paré administered the bezoar stone to the cook, but it had no effect, and the cook died in agony seven hours after taking the poison, proving that – contrary to popular belief – the bezoar could not cure all poisons.[23]

As the demand and price of bezoars increased, counterfeit stones became a major issue. Because real bezoars were valuable and expensive, many traders began selling counterfeit stones, making it difficult to tell which stones were real. While poison trials were conducted to test the effectiveness of the stone, they were not always used to determine their authenticity. Instead, other tests included applying poison on a needle and passing it through a dog's leg, and if the dog survived, then the bezoar stone was considered to be real.[20] The increasing skepticism, counterfeit stones, failed experiments, and advancements in medicine led to a decline in bezoars in Western medicine.

Finger ring with a bezoar stone, from 17th century

Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew Benson of the Scripps Institution of Oceanography show that when bezoars are immersed in an arsenic-laced solution, they can remove the poison. The toxic compounds in arsenic are arsenate and arsenite; each is acted upon differently by the bezoars: arsenate is removed by being exchanged for phosphate in brushite found in the stones, while arsenite is bound to sulfur compounds in the protein of degraded hair, which is a key component in bezoars.[24]

A famous case in the common law of England (Chandelor v Lopus, 79 Eng Rep. 3, Cro. Jac. 4, Eng. Ct. Exch. 1603) announced the rule of caveat emptor ("let the buyer beware") if the goods purchased are not in fact genuine and effective. The case concerned a purchaser who sued for the return of the purchase price of an allegedly fraudulent bezoar.

See also

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References

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  1. ^ (1603) 79 ER 3
  2. ^ "bezoar stone" at Dorland's Medical Dictionary
  3. ^ Bala, Miklosh; Appelbaum, Liat; Almogy, Gidon (November 2008). "Unexpected cause of large bowel obstruction: colonic bezoar". The Israel Medical Association Journal. 10 (11): 829–830. PMID 19070299.
  4. ^ 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.
  5. ^ a b Mintchev MP, Deneva MG, Aminkov BI, Fattouche M, Yadid-Pecht O, Bray RC (1 February 2010). "Pilot study of temporary controllable gastric pseudobezoars for dynamic non-invasive gastric volume reduction". Physiological Measurement. 31 (2): 131–44. Bibcode:2010PhyM...31..131M. doi:10.1088/0967-3334/31/2/001. PMID 20009188.
  6. ^ Buckley NA, Dawson AH, Reith DA (January 1995). "Controlled release drugs in overdose. Clinical considerations". Drug Safety. 12 (1): 73–84. doi:10.2165/00002018-199512010-00006. PMID 7741985.
  7. ^ Kishan, Asn; Kadli, NK (2001). "Bezoars". Bombay Hospital Journal. Archived from the original on 28 August 2008. Retrieved 31 October 2008.
  8. ^ Chung, Y; Han, D; Park, Y; Son, B; Paik, C; Jeon, Y; Sohn, J (July 2006). "Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola". Digestive and Liver Disease. 38 (7): 515–517. doi:10.1016/j.dld.2005.10.024. PMID 16330268.
  9. ^ Ha, Seung Soo; Lee, Hyun Suk; Jung, Min Kyu; Jeon, Seong Woo; Cho, Chang Min; Kim, Sung Kook; Choi, Yong Hwan (2007). "Acute Intestinal Obstruction Caused by a Persimmon Phytobezoar after Dissolution Therapy with Coca-Cola". The Korean Journal of Internal Medicine. 22 (4): 300–303. doi:10.3904/kjim.2007.22.4.300. PMC 2687663. PMID 18309693.
  10. ^ Hayashi, Kazuki; Ohara, Hirotaka; Naitoh, Itaru; Okumura, Fumihiro; Andoh, Tomoaki; Itoh, Takafumi; Nakazawa, Takahiro; Joh, Takashi (December 2008). "Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report". Cases Journal. 1 (1) 385. doi:10.1186/1757-1626-1-385. PMC 2627813. PMID 19077219. Referring to past reports [1-9], the period from the administration of Coca-Cola until the disappearance of the bezoars was a minimum of 1 day and a maximum of 2 months.
  11. ^ Malhotra A, Jones L, Drugas G (November 2008). "Simultaneous gastric and small intestinal trichobezoars". Pediatr Emerg Care. 24 (11): 774–6. doi:10.1097/PEC.0b013e31818c2891. PMID 19018222.
  12. ^ a b c d e f Eng, Katharine; Kay, Marsha (November 2012). "Gastrointestinal bezoars: history and current treatment paradigms". Gastroenterology & Hepatology. 8 (11): 776–778. ISSN 1554-7914. PMC 3966178. PMID 24672418.
  13. ^ "Gastroparesis". Johns Hopkins Medicine. Johns Hopkins University. Retrieved 26 May 2021.
  14. ^ Adler, A. I.; Olscamp, A. (November 1995). "Toxic 'sock' syndrome bezoar formation and pancreatitis associated with iron deficiency and pica". The Western Journal of Medicine. 163 (5): 480–482. ISSN 0093-0415. PMC 1303182. PMID 8533420.
  15. ^ Simpson, Serge-Emile (February 2011). "Pharmacobezoars described and demystified". Clinical Toxicology. 49 (2): 72–89. doi:10.3109/15563650.2011.559472. ISSN 1556-3650. PMID 21370943.
  16. ^ "INTENTIONAL OVERDOSE IN A TEENAGER WITH LATE SALICYLATE TOXICITY SECONDARY TO BEZOAR FORMATION". Critical Care Medicine. 42 (12): 1246 – via Society of Critical Care Medicine journals, Lippencott.
  17. ^ Ladas SD, 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. PMID 23252775.
  18. ^ Merck Manual, Rahway, New Jersey, Sixteenth Edition, Gastrointestinal Disorders, Section 52, p. 780
  19. ^ "Bezoar - Etymology, Origin & Meaning". etymonline. Retrieved 27 April 2026.
  20. ^ a b Rankin, Alisha (2021). The Poison Trials: Wonder Drugs, Experiment, and the Battle for Authority in Renaissance Science. Chicago: The University of Chicago Press. pp. 145–223. ISBN 9780226744711.
  21. ^ a b c d e Stark, Marnie P. (2003). "Mounted Bezoar Stones, Seychelles Nuts, and Rhinoceros Horns: Decorative Objects as Antidotes in Early Modern Europe". Studies in the Decorative Arts. 11 (1): 69–94 – via JSTOR.
  22. ^ Duffin, Christopher J. (2013). A History of Geology and Medicine. London: The Geological Society. pp. 193–206. ISBN 9781862393561.
  23. ^ Paget, Stephen (1897). Ambroise Paré and his times, 1510-1590. Harvard University. New York, London, G.P. Putnam's sons.
  24. ^ "Bezoar Stones". Archived from the original on 16 January 2013. Retrieved 30 November 2012. Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew A. Benson of the Scripps Institution of Oceanography have shown that they could, when immersed in an arsenic-laced solution, remove the poison. The toxic compounds in arsenic are arsenate and arsenite. Each is acted upon differently, but effectively, by bezoar stones. Arsenate is removed by being exchanged for phosphate in the mineral brushite, a crystalline structure found in the stones. Arsenite is found to bond to sulfur compounds in the protein of degraded hair, which is a key component in bezoars.

Bibliography

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Further reading

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  • Borschberg, Peter (2016). "The Euro-Asian Trade in Bezoar Stones (approx. 1500–1700)". In North, Michael (ed.). Artistic and Cultural Exchanges between Europe and Asia, 1400-1900. pp. 29–43. doi:10.4324/9781315262062. ISBN 978-1-315-26206-2.
  • Borschberg, Peter (2006). "O comércio, uso e falsificação dos bezoares de porco-espinho na Época Moderna" [The Trade, Forgery and Medicinal Use of Porcupine Bezoars in the Early Modern Period (c.1500–1750)]. In Pinto, Carla Alferes (ed.). Oriente (in Portuguese). Vol. 14. Lisbon: Fundação Oriente.[ISBN missing][page needed]
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