Pharmacobezoar

pharmacobezoar, otherwise known as a medication bezoar is a persistent concretion of pharmaceutical products within the gastrointestinal tract14. They are commonly found following the intentional overdose of sustained-release medications.

A bezoar is a concretion of foreign material that can form and persist within the gastrointestinal tract. A bezoar should not be confused with a pseudobezoar, which refers to an indigestible object intentionally introduced into the gastrointestinal tract3

Pharmacobezoars are difficult to reliably diagnose and can form in a wide variety of patient under a variety of circumstances4. Clinical treatment also varies vastly depending on the type of medication involved, and its specific pharmacodynamics. In serious cases, including those involving potent or dangerous pharmaceuticals, surgical intervention is often needed to remove the bezoar before toxic levels of the drug are absorbed.

Pathophysiology

When a large volume of medications are ingested either simultaneously, or in rapid succession, they can be forced together through natural digestive processes. As the outer coating is dissolved by digestive juices, the pills can coagulate together, eventually forming a concretion of one large mass of pills. 

There has been documented instances where a bezoar has lead to other signficant disease processes, such as Crohn’s Disease of the Duodenum2. Inversely, there are also cases where a pre-existing condition has lead to the formation of a pharmacobezoar due to the body’s inability to properly digest and absorb some medications.

Categories

There are other various types of bezoars. below is a list of commonly encountered bezoars;

Phytobezoar
– Contains plant material
Trichobezoar – Contains hair
Lactobezoars – Contain milk proteins
Dispyrobezoar – A type of phytobezoar caused by unripe persimmons.
Pharmacobezoar – contains medications or pills.

References

1.
Buckley N, Dawson A, Reith D. Controlled release drugs in overdose. Clinical considerations. Drug Saf. 1995;12(1):73-84. [PubMed]
2.
Eliakim R, Fich A, Libson E, Katz E, Rachmilewitz D. Crohn’s disease of the duodenum presented as pancreatitis due to persimmon bezoar. J Clin Gastroenterol. 1987;9(5):553-555. [PubMed]
3.
Mintchev M, Deneva M, Aminkov B, Fattouche M, Yadid-Pecht O, Bray R. Pilot study of temporary controllable gastric pseudobezoars for dynamic non-invasive gastric volume reduction. Physiol Meas. 2010;31(2):131-144. [PubMed]
4.
Simpson S. Pharmacobezoars described and demystified. Clin Toxicol (Phila). 2011;49(2):72-89. [PubMed]
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  1. […] – Contain milk proteins Dispyrobezoar – A type of phytobezoar caused by unripe persimmons. Pharmacobezoar – contains medications or […]

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