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January 6, 1975

Gastric Phytobezoar

Author Affiliations

Ridgewood, NJ

JAMA. 1975;231(1):26. doi:10.1001/jama.1975.03240130020017

To the Editor.—  The use of endoscopy in the dissolution of gastric phytobezoar (229:1332, 1974) is elegant, but perhaps should be reserved until orally administered enzymes have been tried. The efficacy of cellulase in dissolving phytobezoar was reported by Pollard and Block1 and confirmed by Deal et al.2I encountered a case of phytobezoar in a 56-year-old man with subtotal gastrectomy (Billroth I) nine months following vagectomy for marginal ulcer. His history included ingestion of three oranges per day for several months. On the basis of Pollard's protocol, the patient was given a five-day course of three pulverized Gastroenterase tablets (containing pepsin, pancreatic enzyme concentrate, cellulase, and dehydrocholic acid) after each meal, which he took as an outpatient. An upper gastrointestinal roentgenographic series immediately thereafter showed complete disappearance of the bezoar.This case supports the use of orally administered chemicals for bezoar and recommends it as a noninvasive,