Cellulase is an enzyme that breaks down cellulose, a plant polysaccharide found in cell walls. It is used to treat phytobezoars, lumps of indigestible plant matter that can form in the gastrointestinal tract. Phytobezoars are the most common type of bezoar and are often caused by persimmons. Endoscopy is the best way to diagnose and treat phytobezoars with cellulase injections. Some individuals are more susceptible to developing bezoars, and those who have had one removed should watch their diets to prevent recurrence.
Cellulases are a group of enzymes that break down the plant polysaccharide called cellulose, a structural component of plant cell walls. It is produced by microorganisms, such as plant pathogens, to breach these cell walls and by plants to help fruits soften as they ripen. Cellulase is used medicinally to treat phytobezoars. These are lumps of indigestible plant matter, often containing large amounts of cellulose, that can form in the gastrointestinal tract. The formation of such bezoars can be life threatening.
Cellulose is a long linear chain of glucose molecules that provides rigidity to plant cell walls. Glucose units are linked in a beta configuration, making them difficult to degrade. This is in contrast to the polysaccharides of starch and glycogen, which are also long chains of glucose. These molecules are branched and connected in an alpha configuration, which makes glucose much more accessible. Humans do not produce cellulose, which makes it difficult for them to digest cellulose.
Because humans digest cellulose poorly, it is usually excreted in feces as a component of plant fiber. Sometimes, however, it can build up in the esophagus, stomach, or intestines of sensitive individuals. It typically forms a mass known as a phytobezoar. Another type of bezoar is a trichobezoar, or a tuft of hair that forms when a person has a compulsion to eat their hair. There are also pharmacobezoars, which are aggregates of drugs.
Formation of bezoars is rare, but phytobezoars are the most common type. Of these, persimmons are the most common source. There is even a special term for bezoars caused by persimmons. They are known as disopyrobezoars.
The symptoms of having a phytobezoar are often vague, including a general feeling of gastric discomfort. Filling up quickly, bloating, anorexia and weight loss are other symptoms. Endoscopy is the best way to diagnose a bezoar, which is often missed by barium enemas.
There is an added benefit to using an endoscopy for diagnosis. If a phytobezoar is found, it can be treated immediately with an injection ofcellularase. This is an improvement over the previous treatment, which involved having a patient drink a solution ofcellularase in water for two to seven days. There appear to be no ill effects from these treatments, which are usually very successful.
Some individuals are more susceptible to developing bezoars. These include patients with impaired gastrointestinal anatomy or mobility. People who have had part of their stomach removed are particularly susceptible, as are diabetics who experience gastroparesis or nerve damage to the stomach, particularly if they eat a high-fiber diet. Patients with cystic fibrosis, Guillan-Barre syndrome, hypothyroidism, kidney failure and many other conditions are also vulnerable.
People who have had a phytobezoar removed should watch their diets to prevent a recurrence of this condition. It is important not to follow a diet rich in fiber and above all to avoid raw vegetables and citrus fruits. Bulk laxatives, such as psyllium and perdium, should also be avoided by high-risk individuals.
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