A Case of Esophageal Bezoar in Normal Esophagus, Treated with Coca-Cola

Abstract

Introduction: Bezoar is a mass formed by accumulation of undigested ingested material. They are rare, and are found in less than 1% of patients undergoing UGI endoscopy. Phytobezoars (undigested vegetable matter) are the most common bezoars. Bezoars are commonly seen in the stomach, and esophageal bezoars are very rare. Case: A 65-year-old Caucasian male with a history of interstitial lung disease presented to the ER with shortness of breath. He began coughing up a lot of foam and in the middle of his coughing spells he started having symptoms of dysphagia and odynophagia. Upper GI contrast study revealed a 5-cm ovoid filling defect in the distal third of the esophagus. An EGD was performed and a bezoar was seen in the distal esophagus. During endoscopy Bezoar spontaneously passed into the stomach without any intervention by causing superficial esophageal tear and oozing of blood from it. The bleeding was stopped by injecting the site with 1:10,000 epinephrine and by placing endoclips. Bezoar was injected with 30-50 ml of coca-cola and the patient was placed on coca-cola diet (two cans of diet coca-cola TID) for the next three days. Follow up UGI contrast study did not reveal any bezoar, indicating the complete dissolution of the bezoar. Discussion: Esopahgeal bezoars usually form in patients with esophageal dysmotility or achalasia. Here, we describe a bezoar in normal esophagus, at most with possible Schatzki's Ring. Bezoars can be treated either chemically, endoscopically or surgically. Chemical treatment is very effective for phytobezoars. Coca-cola is a safe, inexpensive, easily available and effective method to achieve complete dissolution of phytobezoars. Our case adds to the limited existing evidence for the use of coca-cola in dissolving phytobezoars.