Bezoar

For the animal, see Bezoar Ibex.

Bezoar stones were seen as valuable commodities, sometimes with magical healing properties, as in the old English case Chandelor v Lopus^[1]

Bezoar
Classification and external resources
ICD-10	T18
ICD-9	938
DiseasesDB	30758
MedlinePlus	001582
MeSH	D001630

A bezoar (/ˈbiːzɔər/) is a mass found trapped in the gastrointestinal system (usually the stomach),^[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.

History

Bezoars were sought because they were believed to have the power of a universal antidote against any poison. It was believed that a drinking glass which contained a bezoar would neutralize any poison poured into it. The word "bezoar" comes from the Persian pâdzahr (پادزهر), which literally means "antidote".

In 1575, the surgeon Ambroise Paré described an experiment to test the properties of the bezoar stone. At the time, the bezoar stone was deemed to be able to cure the effects of any poison, but Paré believed this was impossible. It happened that a cook at Paré's court was caught stealing fine silver cutlery. In his shame, the cook agreed to be poisoned. He then used the bezoar stone to no great avail, as he died in agony seven hours later.^[6] Paré had proved that the Bezoar stone could not cure all poisons as was commonly believed at the time.

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 they 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. (How the plaintiff discovered the bezoar did not work is not discussed in the report.)

The Merck Manual of Diagnosis and Therapy notes that consumption of unripened persimmons has been identified as causing epidemics of intestinal bezoars, and that up to 90% of bezoars that occur from eating too much of the fruit require surgery for removal.^[7]

Types by content

• Food boluses (or boli, singular, bolus) imitate true bezoars 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.
• Lactobezoar is a specific type of food bezoar comprising 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 overdose of sustained release medications.^[8]
• 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 bezoar formed from unripe persimmons.^[9] Coca-Cola has been used in the treatment.^[10][11]
• Trichobezoar is a bezoar formed from hair^[12] - an extreme form of hairball. Humans who frequently consume hair sometimes require these to be removed. The Rapunzel syndrome, a very rare and extreme case, may require surgery.

Types by location

• A bezoar in the esophagus is common in young children and in horses. In horses, it is known as choke.
• A bezoar in the large intestine is known as a fecalith.
• A bezoar in the trachea is called a tracheobezoar.

Uses of bezoars

• Esophageal bezoars in the nasogastrically fed patients on mechanical ventilation and sedation have been reported to be due to precipitation of certain food types rich in casein, which get precipitated with gastric acid reflux to form esophageal bezoars.
• Ox bezoars (cow bezoars) are used in Chinese herbology, where they are called niu-huang (牛黃) or calculus bovis.^[13] In some products, they claim to remove toxins from the body.
• In alchemy, "animal bezoar" is the heart and lungs of the viper, pulverized together.^[14] Mineral bezoar is an emetic powder of antimony, correct with spirit of nitre, and softened by repeated lotions, which were said to carry off the purgative virtue of the antimony, and substitute a diaphoretic one. It promoted sweat like the stone of the same name.^[14]

References in popular culture

• Bezoars are given a passing mention in the Harry Potter books. In the first book, Harry Potter and the Philosopher's/Sorcerer's Stone, Potions Master Severus Snape tests Harry's knowledge to humiliate him on his first day at Hogwarts. In the sixth book, Harry Potter and the Half-Blood Prince, Harry follows notes in the margin of his borrowed textbook to impress recently-returned Horace Slughorn, and presents a bezoar in response to a particular in-class assignment. Shortly thereafter, he uses the same bezoar to save Ron Weasley from poisoned mead.

• In Promethean: The Created, the inhuman Centimani can develop a "perfected" bezoar as a supernatural power, rendering them resistant or immune to various forms of attack.

See also

• Bezoardicum
• Enterolith
• Regurgitalith
• Snake-stones
• List of English words of Persian origin

Notes

1. ^ (1603) 79 ER 3
2. ^ "bezoar" at Dorland's Medical Dictionary
3. ^ 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. 
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: 13. doi:10.1186/1471-230X-3-13. PMC 165420. PMID 12795814. http://www.biomedcentral.com/1471-230X/3/13. 
5. ^ 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". Physiol. Meas. 31 (2): 131–44. doi:10.1088/0967-3334/31/2/001. PMID 20009188. http://iopscience.iop.org/0967-3334/31/2/001/. 
6. ^ Stephen Paget (1897). Ambroise Paré and His Times, 1510–1590. G.P. Putnam's sons. pp. 186–187. http://books.google.com/?id=s2PsYxqqiSIC. 
7. ^ Merk Manual, Rahway, New Jersey, Sixteenth Edition, Gastrointestinal Disorders, Section 52, page 780
8. ^ Buckley NA, Dawson AH, Reith DA (January 1995). "Controlled release drugs in overdose. Clinical considerations". Drug Safety: an International Journal of Medical Toxicology and Drug Experience 12 (1): 73–84. PMID 7741985. 
9. ^ Kishan, Asn; Kadli, NK (2001). "Bezoars". Bombay Hospital Journal. http://www.bhj.org/journal/2001_4304_oct/org_507.htm. 
10. ^ Chung YW, Han DS, Park YK, et al. (July 2006). "Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola". Dig Liver Dis 38 (7): 515–7. doi:10.1016/j.dld.2005.10.024. PMID 16330268. http://linkinghub.elsevier.com/retrieve/pii/S1590-8658(05)00477-9. 
11. ^ Ha SS, Lee HS, Jung MK, et al. (December 2007). "Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola". Korean J. Intern. Med. 22 (4): 300–3. doi:10.3904/kjim.2007.22.4.300. PMC 2687663. PMID 18309693. http://www.kaim.or.kr/journal/view2.php?year=2007&vol=22&no=4&page=300. 
12. ^ 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. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006565-200811000-00010. 
13. ^ Ingredients, AN KUNG NIU HUANG WAN (Bezoar Chest Functioning Pills), Peking Tung Jen Tang, Peking, China. 1980.
14. ^ ^{a b} Chambers, Ephraim (1728). "Bezoar". Cyclopaedia, or an Universal Dictionary of Arts and Sciences. 1. London. p. 98b. 

References

• Barry Levine. 1999. Principles of Forensic Toxicology. Amer. Assoc. for Clinical Chemistry. ISBN ISBN 1-890883-87-5.
• Martín-Gil FJ, Blanco-Ávarez JI, Barrio-Arredondo MT, Ramos-Sanchez MC, Martin-Gil J. Jejunal bezoar caused by a piece of apple peel - Presse Med, 1995 Feb 11;24(6):326.
• The Poison Sleuths: Arsenic - The King of Poisons. Retrieved March 10, 2007. (This webpage is a reprint by the author of an article originally published in the 1997 issue of Science Reporter, published by the National Institute of Science Communication (CSIR) in India.)
•  This article incorporates content from the 1728 Cyclopaedia, a publication in the public domain.

Further Reading

• Borschberg, Peter, "The Euro-Asian Trade in Bezoar Stones (approx. 1500-1700)", Artistic and Cultural Exchanges between Europe and Asia, 1400-1900: Rethinking Markets, Workshops and Collections, edited by Thomas DaCosta Kaufmann and Michael North, Aldershot: Ashgate, 2010, pp. 29-43.

• Borschberg, Peter, "The Trade, Forgery and Medicinal Use of Porcupine Bezoars in the Early Modern Period (c.1500-1750)", ed. by Carla Alferes Pinto, Oriente, vol. 14, Lisbon: Fundação Oriente, 2006.

External links

• A trichobezoar at the National Museum of Health and Medicine, Washington DC.
• Bezoars, Phytobezoars and Diospyrobezoars
• A trichobezoar from MedPix
• CT images of bezoar from MyPACS.net