A bezoar is a mass found trapped in the gastrointestinal system, though it can occur in other locations.
A pseudobezoar is an indigestible object introduced intentionally into the digestive system.
There are several varieties of bezoar, some of which have inorganic constituents and others
organic. The term has both a modern and a traditional usage.
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 pād-zahr, which literally means "antidote".
The Andalusian physician Ibn Zuhr, known in the West as Avenzoar, is thought to have made
the earliest description of bezoar stones as medicinal items. Extensive reference to
it is also to be found in the Picatrix, which may be earlier.
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 King's
court was caught stealing fine silver cutlery and was sentenced to death by hanging. The
cook agreed to be poisoned instead. Ambroise Paré then used the bezoar stone to no great
avail, as the cook died in agony seven hours later. Paré had proved that the bezoar stone
could not cure all poisons as was commonly believed at the time.
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.
A famous case in the common law of England 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. 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. A 2013 review of 3 databases identified 24
publications presenting 46 patients treated with Coca-Cola for phytobezoars. The cola
was administered in doses of 500 mL to up to 3000 mL 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, others requiring the cola plus endoscopic removal. Surgical
removal was resorted to in four patients. Types by content
Food boluses carry 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.
Lactobezoar is a specific type of food bezoar comprising inspissated milk. It is most commonly
seen in premature infants receiving formula foods.
Pharmacobezoars are mostly tablets or semiliquid masses of drugs, normally found following
overdose of sustained-release medications. Phytobezoars are composed of indigestible
plant material, and are frequently reported in patients with impaired digestion and decreased
gastric motility. Diospyrobezoar is type of phytobezoar formed
from unripe persimmons. Coca-Cola has been used in the treatment.
Trichobezoar is a bezoar formed from hair – 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. Production and 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 are used in Chinese herbology, where they are called niu-huang or calculus
bovis. These are gallstones, or substitutes, from ox or cattle gall bladder bile. There
are artificial calculus bovis used as substitutes. These are manufactured from cholic acid derived
from bovine bile. 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. Mineral
bezoar is an emetic powder of antimony, correct with nitric acid, 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.
See also Bezoardicum
Enterolith Gorochana
Regurgitalith Snake-stones
List of English words of Persian origin References
Notes
Bibliography Barry Levine. 1999. Principles of Forensic
Toxicology. Amer. Assoc. for Clinical Chemistry. 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. in India.)
This article incorporates text from a publication now in the public domain: Chambers, Ephraim,
ed.. "article name needed". Cyclopædia, or an Universal Dictionary of Arts and Sciences.
James and John Knapton, et al. Further reading
Borschberg, Peter, "The Euro-Asian Trade in Bezoar Stones", Artistic and Cultural Exchanges
between Europe and Asia, 1400–1900: Rethinking Markets, Workshops and Collections, ed. 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", ed. 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