ESOPHAGEAL BEZOAR RESULTING FROM ENTERAL FEEDINGS

Esophageal bezoars are rare but are known to occur in patients with st ructural or functional abnormalities of the esophagus. Additionally, s ucralfate and casein containing enteral feeding formulas have been imp licated in the formation of esophageal bezoars, particularly in the se tting of decreased esophageal pH. We present a case in which a patient with functional impairment of the esophagus related to myasthenia gra vis developed an esophageal bezoar. Gastroesophageal reflux, altered e sophageal pH, and direct instillation of feeding formula through a ren t in the feeding tube were additional factors Likely leading to bezoar formation in this patient. Endoscopic examination revealed puttylike material consistent with coagulated enteral feeding formula. An esopha gram demonstrated a large bezoar filling the middle and distal thirds of the esophagus. The conditions predisposing to bezoar formation and the proposed mechanisms are discussed. We also summarize the reported cases of esophageal bezoars related to enteral feeding formula, sucral fate, or both.