Update on the medicinal management of phytobezoars.

The purpose of this review article is to provide the clinician with complete information concerning available medicinal agents for the management of phytobezoars. Data sources were obtained by a Medline search from 1966 to present. All citations containing references to patients with a phytobezoar treated with medicinal agents were selected and reviewed for treatment regimen, number of patients treated, length of therapy, success rate, and adverse effects. A total of 36 patients with phytobezoars were reviewed. Papain was successful in treating 87% (13 of 15) and cellulase in 100% (19 of 19) of the patients. Adverse effects reported in the papain group were gastric ulcer, esophageal perforation, and hypernatremia; the cellulase group did not report any adverse effects. Papain and cellulase appeared to be effective in the management of phytobezoars in the small number of patients studied. However, controlled clinical trials are needed to compare the safety and efficacy of the two agents.