Carbonated soda treatment of phytobezoars is the use of carbonated soda to try to dissolve a

phytobezoar A phytobezoar is a type of bezoar, or trapped mass in the gastrointestinal system, that consists of components of indigestible plant material, such as fibres, skins and seeds. While phytobezoars may be discovered incidentally on barium x-ray or e ...

. Bezoars consist of a solid and formed mass trapped in the

gastrointestinal system The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. T ...

, usually in the

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

. These can also form in other locations. 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. It is one of many other stomach disorders that can have similar symptoms. 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 Lignin is a class of complex organic polymers that form key structural materials in the support tissues of most plants. Lignins are particularly important in the formation of cell walls, especially in wood and bark, because they lend rigidit ...

cellulose Cellulose is an organic compound with the chemical formula, formula , a polysaccharide consisting of a linear chain of several hundred to many thousands of glycosidic bond, β(1→4) linked glucose, D-glucose units. Cellulose is an important s ...

tannin Tannins (or tannoids) are a class of astringent, polyphenolic biomolecules that bind to and Precipitation (chemistry), precipitate proteins and various other organic compounds including amino acids and alkaloids. The term ''tannin'' is widel ...

celery Celery (''Apium graveolens'' Dulce Group or ''Apium graveolens'' var. ''dulce'') is a cultivated plant belonging to the species ''Apium graveolens'' in the family Apiaceae that has been used as a vegetable since ancient times. The original wild ...

pumpkin A pumpkin is a cultivar, cultivated winter squash in the genus ''Cucurbita''. The term is most commonly applied to round, orange-colored squash varieties, but does not possess a scientific definition. It may be used in reference to many dif ...

skin,

grape A grape is a fruit, botanically a berry, of the deciduous woody vines of the flowering plant genus ''Vitis''. Grapes are a non- climacteric type of fruit, generally occurring in clusters. The cultivation of grapes began approximately 8,0 ...

skins,

prune A prune is a dried plum, most commonly from the European plum (''Prunus domestica'') tree. Not all plum species or varieties can be dried into prunes. Use of the term ''prune'' for fresh plums is obsolete except when applied to varieties of ...

raisin A raisin is a Dried fruit, dried grape. Raisins are produced in many regions of the world and may be eaten raw or used in cooking, baking, and brewing. In the United Kingdom, Republic of Ireland, Ireland, New Zealand, Australia and South Afri ...

s, vegetables and fruits. Phytobezoars can form after eating

persimmon The persimmon () is the edible fruit of a number of species of trees in the genus '' Diospyros''. The most widely cultivated of these is the Chinese and Japanese kaki persimmon, ''Diospyros kaki''. In 2022, China produced 77% of the world's p ...

s and

pineapple The pineapple (''Ananas comosus'') is a Tropical vegetation, tropical plant with an edible fruit; it is the most economically significant plant in the family Bromeliaceae. The pineapple is indigenous to South America, where it has been culti ...

s. These are more difficult to treat and are referred to as diospyrobezoars.

Treatment

Carbonated soda may help to dissolve phytobezoars. It can be given by a naso-gastric tube in children. Carbonated soda can also be given by mouth and during

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

. It is effective in about half of the cases. It promotes dissolution by endoscopic techniques in the majority of the patients left, leading to a final success rate up to 91.3%. In some cases, regular use of

Coca-Cola Coca-Cola, or Coke, is a cola soft drink manufactured by the Coca-Cola Company. In 2013, Coke products were sold in over 200 countries and territories worldwide, with consumers drinking more than 1.8 billion company beverage servings ...

resulted in no recurrence 3–15 months after the first episode. Treatment has varied widely. Coca-Cola has been administered 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. Alternative treatments are the use of cellulase, acetylcysteine, papain, pancreatic enzymes, saline solution, 0.1 N HCl and sodium bicarbonate. The protocol for the treatment of phytobezoars with Coca-Cola, i.e., dosage and timing, has not been standardized; further investigation has been encouraged.

Contraindications

Trichobezoar A hairball is a small collection of hair or fur formed in the stomach of animals, and uncommonly in humans, that is occasionally vomited up when it becomes too big. Hairballs are primarily a tight elongated cylinder of packed fur, but may incl ...

s do not respond to treatment with Coca-Cola but instead this type may have to be surgically removed. 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.

Adverse effects and interactions

Adverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation. 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 interactions

In addition to Coca-Cola,

meat tenderizer A meat tenderizer or meat pounder is a tool for mechanically tenderizing and flattening slabs of meat. Meat tenderizers come in at least three types: * The first, most common, is a tool that resembles a hammer or mallet made of metal or wood ...

has been used to dissolve bezoars of the stomach. When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%. The mechanism by which Coca-Cola dissolves the bezoar is based upon its low pH, CO₂ bubbles, and

sodium bicarbonate Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda (or simply “bicarb” especially in the UK) is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cat ...

content. :::"...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 Pepsi is a Carbonated water, carbonated soft drink with a cola flavor, manufactured by PepsiCo which serves as its flagship product. In 2023, Pepsi was the second most valuable soft drink brand worldwide behind Coca-Cola; the two share a long ...

will do the trick, assuming it does not cause

dysPEPSIa Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier ...

." 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. Coca-Cola has a pH of 2.6. This is due to carbonic and

phosphoric acid Phosphoric acid (orthophosphoric acid, monophosphoric acid or phosphoric(V) acid) is a colorless, odorless phosphorus-containing solid, and inorganic compound with the chemical formula . It is commonly encountered as an 85% aqueous solution, ...

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.

History

A phytobezoar was first successfully treated with Coca-Cola lavage in 2002.

References

{{Digestive system diseases, state=collapsed Stomach disorders Medical treatments Gastrointestinal tract disorders Carbonated drinks