| Background:Bezoar,also known as gastritis,refers to the eating of indigestible food that cannot be emptied in time,congealed into clumps in the stomach,or congealed with gastric mucus and plant fibers,which can be seen in the esophagus,stomach and little intestine,etc.,and mostly formed in the stomach.It can be divided into(1)Phytobezoar;(2)Trichobezoar;(3)Pharmacobezoar;(4)Lactobezoar;(5)Other types of bezoar.Among them,gastropersimmons is the most common clinical bezoar.Persimmons usually appear in the market in autumn and winter every year.That’s why there are many reports about gastropersimmons.gastropersimmons can cause upper abdominal discomfort,abdominal pain,abdominal distension and other clinical symptoms,and can furthermore lead to ulcers,bleeding,obstruction or perforation and other complications,which seriously affect people’s health and quality of daily life.Research content:At present,the clinical treatment of gastropersimmons is mainly based on mechanical entrapment lithotripsy under the gastroscope and solvent dissolution,which has achieved effective results.However,the mechanical entrapment lithotripsy under the gastroscope is easy to cause deformation and distortion of the entrapment,and the size of the residual gastroliths should be controlled during the extraction process,which is too large and easy to cause damage and bleeding in the relatively narrow parts of the digestive tract such as the stomach,cardiac,esophagus and throat,and takes a long time.Increase the risk of painful or painless anesthesia.In terms of solvent dissolution,clinical data confirmed the clinical efficacy of cola in the treatment of gastric persimmon stones,but the mechanism of cola’s action was not clear,which could not explain why the strong acid secreted by the body in large quantities every day,namely gastric acid,could not dissolve gastric stones,while the relatively weak acid,Coca-Cola,could work.After endoscopic lithotripsy combined with solvent dissolution treatment,a small number of stones still cannot be ablated,and there is a risk of intestinal obstruction during the discharge of the remaining lithotripsy.There have been domestic news reports,cases of small intestinal obstruction and anal obstruction caused by the residual mass formed again in patients with gastric persimmon stone broken under the endoscope.In this paper,the main object of study is stomach persimmon stone,aiming to find clues by identifying chemical means,explore the insoluble mechanism of stomach persimmon stone,and specifically solve the current clinical dilemma.Research Methods and results:In this paper,through daily clinical observation,it was found that gastric persimmon stone can be divided into surface layer and inner layer.The surface layer is brown and black brown thin slice,the surface is smooth or coated with mucus,and the inner layer is yellow,loose and rough mass,similar to undigested persimmon fruit.According to the difference of properties and characters between the surface layer and inner layer of gastropersimmons,a series of tests were carried out on the surface layer and inner layer of gastropersimmons by means of infrared spectrum analysis,Raman spectrum analysis and scanning electron microscopy,and the functional differences caused by the structural differences of gastropersimmon stone were deeply studied.After the safety test of solvent on mice,the surface and inner layer drop dissolution experiment and the immersion ablation experiment of gastric persimmon stone were carried out.The main research results are as follows:(1)The infrared spectrum analysis results showed that the "fingerprint region" of the surface and inner layers of the stomach persimmon stone was consistent with the "fingerprint region" of the pectin sample,which was identified as pectin composition.The stretching vibration peaks of the inner layer(1444)and esterified carboxyl group(1760)were stronger than those of the outer layer,indicating a high degree of methylation and esterification.Surface pectin may interact with calcium ions to promote gel at PH0.9-1.5 acid in the stomach,thus forming an antacid barrier that is difficult to ablate.(2)The collected samples of persimmon and pectin were detected by Raman spectral analysis.The samples of persimmon were mixtures,and the Raman spectral analysis was subject to the possibility of confounding factors error,so no valuable results were obtained.(3)Scanning electron microscope analysis of the surface and inner layer of the stomach persimmon stone were respectively scanned and observed,and it was found that the surface layer of the stomach persimmon stone was almost seamless and dense,and the smoothness was obviously higher than that of the inner layer.The inner layer has more granular uneven,the whole is compressed stacked conformation.Part of the side section has a sense of granular,flocculent,and the surface structure is more compact.Due to the damage of EDX component,the development of calcium and other elements could not be completed.(4)Safety experiment of solution on gastric tissues of mice: In order to avoid potential damage to gastric tissues by subsequent experimental reagents,animal experiments were conducted in Institute of Experimental Animals,Chinese Academy of Medical Sciences.C57BL/6 mice(4months old)were divided into three groups: classic Coca-Cola (?)(pH2.5),5% sodium bicarbonate solution(pH8.41)and standard alkali solution(pH9.18),with 3 mice in each group,200μL daily.After 5 days of continuous gavage,gastric tissues of mice were collected.The pathological tissue injury was observed.Results Only the standard lye had little damage to the stomach,and the overall safety was good.Subsequent experiments of drip dissolution and ablation of gastric persimite could be carried out.(5)Drip dissolution experiment on the surface and inner layer of stomach persimmon stone: Through the drip solubilization of standard lye(pH9.18),5%sodium bicarbonate solution(pH8.41),CO2-free Classic Coca-Cola (?)(pH2.5),Classic Coca-Cola (?)(pH2.5),and standard gastric juice(pH1.2)on the surface and inner layer of the stomach persimmon stone,the surface layer of the stomach persimmon stone showed that it had corrosion resistance to both acidic and alkaline liquids.It has the function of acid-base resistance barrier.The inner layer of stomach persimmon stone shows resistance to acid fluid erosion,but alkaline fluid may be able to erosion,more verification is needed.(6)Immersion ablation experiment of gastric persimmon stone: Two kinds of standard lye containing pectinase(pH9.18),5% sodium bicarbonate solution(pH8.41),CO2-free classic Coca Cola (?)(pH2.5),classic Coca Cola (?)(pH2.5)and standard gastric juice(pH1.2)were used for 24 hours of immersion ablation.The results showed that,The addition of pectinase can greatly improve the ablation of gastric persimmon stone.The ablation degree of weishi is higher in alkaline environment.Due to the limited number of samples collected,the experiment could not be repeated for many times,which lacked statistical significance,but it is believed to have played an enlightening significance for future further research.Based on the above experimental results,a new mechanism analysis of insoluble persimmon stone can be proposed,that is,persimmon reacts with gastric acid after eating a large amount of persimmon.Under the joint action of gastric acid and calcium ions,the surface pectin converts to low methylate esterylation and gels to form an antacid barrier,and even chelates with trace elements to form complexes such as calcium pectin and iron pectin to form an antacid barrier.The strength of gastric persimmon stone was improved by compression and stacking of gastric creep force,and finally the high strength gastric persimmon stone with intact structure and acid resistant barrier was formed. |
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