Should papain be used to break down bezoar? Why?

• A. Yes, it dissolves plant fibers quickly
• B. Yes, it is safe under supervision
• C. No, because it breaks down normal tissue and is associated with peptic ulcer disease, esophagitis and gastritis
• D. Papain should be used only if cola fails

Answer: (C)

The main idea is safety in managing bezoars. Papain is a proteolytic enzyme, meaning it digests proteins. When used in the GI tract, it can damage normal mucosal tissues—eroding the lining of the esophagus or stomach and potentially leading to peptic ulcers, esophagitis, or gastritis. Because of this tissue-destructive potential, papain is not recommended for bezoar dissolution.

Plant-based bezoars are largely fiber (cellulose)—and papain targets proteins, not fiber fibers. This makes papain both unsafe and unlikely to be effective. Safer approaches (like endoscopic fragmentation or other non-damaging dissolution methods) are preferred rather than using a mucosa-damaging enzyme. The options suggesting it’s harmless or that it dissolves fibers quickly aren’t accurate, and the notion of using it only after cola failure isn’t appropriate given the mucosal injury risk.