A 59-year-old man was admitted to our department with epigastric pain and nausea.
The patient mentioned that he had swallowed heated mastic to treat constipation shortly
before his symptoms developed. He had no history of any diseases. His vital signs
were within normal limits. The physical examination findings were normal, and the
results of laboratory tests were unremarkable.
Upper gastrointestinal endoscopy revealed a gastric bezoar 6 to 7 cm in diameter ([Fig. 1]). Although there is uncertainty concerning the volume of pineapple juice, we recommended
that our patient drink 1 L of fresh pineapple juice 3 times a day (once after each
meal) for the next 2 weeks. The patient again underwent upper gastrointestinal endoscopy
after the ingestion of fresh pineapple juice. We found that the gastric bezoar had
dissolved completely ([Fig. 2]), so that surgery could be avoided.
Fig. 1 Endoscopic image of a gastric bezoar before the ingestion of pineapple juice.
Fig. 2 The bezoar has dissolved after the ingestion of pineapple juice.
Gastric bezoars are unusual. They are frequently associated with peptic ulcer, diabetes
mellitus, or gastric surgery. In the medical literature, many invasive and noninvasive
methods to dissolve gastric bezoars, such as mechanical fragmentation and medical
treatment, have been described [1, 2]. The consumption of pineapple juice as a noninvasive
method to dissolve bezoars has also been reported [3]. The putative mechanism of dissolution
is that pineapple juice is rich in bromelain, a proteolytic enzyme. We are the first
to report the administration of pineapple juice to dissolve a gastric bezoar caused
by swallowing heated mastic.
Endoscopy_UCTN_Code_TTT_1AO_2AL
