Issue: 2017 > June > photo quiz

Answer to Photo Quiz: An unexpected cause of nausea and vomiting in a patient with metastasised lung cancer

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Unexpectedly, gastroscopy revealed a large bezoar located in the stomach (8 x 3 cm, figure 1a, b). Endoscopic manipulation of the mass was performed to dissect the mass into smaller pieces and allow further passage into the duodenum. Additionally, the patient was treated with domperidone (10 mg orally 4 times a day) and two litres of Coca-Cola in 24 hours. Her symptoms resolved rapidly and she was discharged home two days later. 
Bezoars are masses that may be formed from food, medication or hair, which are trapped within the gastrointestinal system.1 Enteral tube feeding combined with opioids and sucralfate, which the patient used, is associated with development of a bezoar, presumably due to gastric dysmotility and the formation of insoluble complexes between sucralfate and nutritional proteins.2 A systemic review analysis, largely based on case reports and including 46 patients, revealed that Coca-Cola administration as monotherapy can successfully resolve a phytobezoar in half the cases and in more than 90% when combined with endoscopic intervention. Only a minority of the patients (9%) needed additional surgical intervention to remove the bezoar.3 The chances of success with cola are higher for phytobezoars, which contain indigestible plant material, than for diospyrobezoars, which are formed from persimmon (sharon fruit and kaki).1,3 Alternatively, surgical removal or enzymatic digestion may be needed.2,3


  1. Iwamuro M, Okada H, Matsueda K, et al. Review of the diagnosis and management of gastrointestinal bezoars. World J Gastrointest Endosc. 2015;7:336-45. 
  2. Gil-Almagro F, Carmona-Monge FJ. Oesophageal bezoar as a complication of enteral nutrition in critically ill patients. Two case studies. Intensive Crit Care Nurs. 2016;32:29-32. 
  3. Ladas SD, Kamberoglou D, Karamanolis G, et al. Systematic review: Coca-cola can effectively dissolve gastric phytobezoars as a first-line treatment. Aliment Pharmacol Ther. 2013;37:169-73.