Carbonated soda treatment of phytobezoars is the use of carbonated soda to try to dissolve a phytobezoar. Bezoars consist of a solid and formed mass trapped in the gastrointestinal system, usually in the stomach.[1] [2] These can also form in other locations.[3] [4]
Carbonated soda has been proposed for the treatment of gastric phytobezoars. In about 50% of cases studied, carbonated soda alone was found to be effective in gastric phytobezoar dissolution. Unfortunately, this treatment can result in the potential of developing small bowel obstruction in a minority of cases, necessitating surgical intervention.[1] It is one of many other stomach disorders that can have similar symptoms.
Gastric phytobezoars are a form of intestinal blockage and are seen in those with poor gastric motility. The preferred treatment of bezoars includes different therapies and/or fragmentation to avoid surgery. Phytobezoars are most common and consist of various undigested substances including lignin, cellulose, tannins, celery, pumpkin skin, grape skins, prunes, raisins, vegetables and fruits.[1] Phytobezoars can form after eating persimmons and pineapples. These are more difficult to treat and are referred to as diospyrobezoars.
Carbonated soda may help to dissolve phytobezoars.[5] It can be given by a naso-gastric tube in children.[6] Carbonated soda can also be given by mouth and during endoscopy.[7] It is effective in about half of the cases.[5]
It promotes dissolution by endoscopic techniques in the majority of the patients left, leading to a final success rate up to 91.3%.[8] In some cases, regular use of Coca-Cola resulted in no recurrence 3–15 months after the first episode.[8] Treatment has varied widely. Coca-Cola has been administered either as drinking beverage or as lavage. Some are treated with various combinations of drink, injection and irrigation. The volume of Coca-Cola in treatment varies along with daily dose and time of treatment. Dosages varied from 500 mL up to 3000 mL and treatment period 24 hours to 6 weeks. When lavage is used, a double-lumen nasogastric tube or two separate tubes using 3000 mL of Coca-Cola is administered during a 12-hour period.[8] Alternative treatments are the use of cellulase, acetylcysteine, papain, pancreatic enzymes, saline solution, 0.1 N HCl and sodium bicarbonate. The protocol for the treatment of phytobezoars with Coca-Cola, i.e., dosage and timing, has not been standardized; further investigation has been encouraged.[1]
Trichobezoars do not respond to treatment with Coca-Cola but instead this type may have to be surgically removed.[7] Persimmon diospyrobezoars sometimes are resistant to Coca-Cola and require a different treatment. This can include endoscopic fragmentation and/or surgical approaches especially in urgent cases where the patient exhibits gastrointestinal bleeding.[1] [8]
Adverse effects have been observed with the use of papain such as gastric ulcer, hyponatremia and oesophageal perforation.[8] These effects have not been observed with the use of Coca-Cola. Glucose levels during the administration of Coca-Cola have not been addressed.
In addition to Coca-Cola, meat tenderizer has been used to dissolve bezoars of the stomach.[9] [10] When treatment with Coca-Cola is combined with endoscopic methods, the success of treatment approaches 90%.[8] The mechanism by which Coca-Cola dissolves the bezoar is based upon its low pH, CO2 bubbles, and sodium bicarbonate content.[7]
"...patients given a continuous infusion of Coca-Cola by nasogastric tube over 12 hours showed complete resolution of bezoars. If you cannot find a can of Coke, perhaps Pepsi will do the trick, assuming it does not cause dysPEPSIa."[9]
Some clinicians have described the mode of interaction is based upon the acidification of the gastric contents and the release of CO2 that causes disintegration. Three and a half liters given nasogastrically over 12 hours has been found to dissolve these bezoars.[11] Coca-Cola has a pH of 2.6. This is due to carbonic and phosphoric acid which resemble gastric acid. Gastric acid is believed to facilitate the digestion of fibers. In Coca-Cola, NaHCO3 has a mucolytic effect and CO2 bubbles enhance dissolving the bezoar. Coca-Cola reduces the size and softens the make-up of the bezoar, and combined with other treatments, enhances the dissolution.[8]
A phytobezoar was first successfully treated with Coca-Cola lavage in 2002.[1]