Treatment for gastric phytobezoars includes all of the following EXCEPT

• A. Flushing with cola
• B. Enzymatic therapy with cellulase
• C. Meat tenderizer that contains papain
• D. Surgical removal of the bezoar

Answer: (C)

Gastric phytobezoars are made mostly of plant fibers like cellulose, so effective treatments target dissolving those cellulose components or physically removing the mass when needed. Flushing with cola can help soften and fragment the bezoar due to its acidity and carbonation, sometimes assisting subsequent endoscopic fragmentation. Enzymatic therapy with cellulase is designed to break down cellulose, directly addressing the main constituent of phytobezoars. Surgical removal is a fallback for large or obstructive bezoars or when non-surgical methods fail. A meat tenderizer containing papain, however, is not a reliable or recommended option for phytobezoars because papain digests proteins, not cellulose, and can irritate or injure gastric mucosa without effectively dissolving the bezoar.