Table 2.
Pathogenetic factors reported/postulated with gastric lactobezoar
| Pathogenetic factor | reported*) | postulated$) |
|---|---|---|
| Exogenous | ||
| "Overconcentrated" formula | 18 (18.8) | 14 (35.0) |
| Calorie content > 80 kcal/100 ml | 63 (65.6) | 6 (15.0) |
| Special LBW formula | 52 (54.2) | 10 (25.0) |
| Breast milk fortifier | 4 (4.2) | 5 (12.5) |
| Protein concentration > DRI#) | 9 (9.4) | 4 (10.0) |
| Casein predominance > 60% | 52 (54.2) | 8 (20.0) |
| Cow's milk protein | 1 (1.0) | 3 (7.5) |
| Medium chain triglycerides | 52 (54.2) | 11 (27.5) |
| Increased Ca-content of formula | - | 3 (7.5) |
| Increased Ca/P ratio of formula | - | 3 (7.5) |
| Silica (Gelopectose) | 3 (3.1) | 3 (7.5) |
| Alginate (Gaviscon) | 2 (2.1) | 1 (2.5) |
| Pectin-lignin-cellulose(Aroban) | 1 (1.0) | 2 (5.0) |
| Atropin (e.g. Eumydrin®) | 2 (2.1) | 3 (7.5) |
| Antacids (Sucralfate® Aluminium hydroxide etc.) | 3 (3.1) | 5 (12.5) |
| Modes of feeding - oral - gavage - bolus - continuous | 29 (30.2) | 7 (17.5) |
| Age < 14 days at start of > 80 kcal formula | 35 (36.5) | 6 (15.0) |
| Supine body position (poor gastric mixing) | 9 (9.4) | 3 (7.5) |
| Phototherapy prior to lactobezoar diagnosis | 16 (16.7) | 3 (7.5) |
| Increased sweating (due to hot weather) | 1 (1.0) | 2 (5.0) |
| Endogenous | ||
| Prematurity | 54 (56.3) | 21 (52.5) |
| Low birth weight (< 2500 gm) | 52 (54.2) | 8 (20.0) |
| Dehydration | 12 (12.5) | 11 (27.5) |
| Increased gastric absorption of fluids | - | 3 (7.5) |
| Decreased global gastric secretion | 3 (3.1) | 2 (5.0) |
| Interaction of formula with gastric secretion | - | 2 (5.0) |
| Increased osmolality of gastric content | 1 (1.0) | 1 (2.5) |
| Delayed gastric emptying | 3 (3.1) | 16 (40.0) |
| Postprandial time course of gastric acidity | - | 1 (2.5) |
| Decreased "digestive capacity" | - | 3 (7.5) |
| Decreased enzyme activity | - | 2 (5.0) |
| Gastric Ca secretion | - | 3 (7.5) |
| Gastric Ca+fat/protein precipitates | 1 (1.0) | 3 (7.5) |
| Respiratory distress syndrome | 14 (14.6) | 6 (15.0) |
| Birth asphyxia | 9 (9.4) | 4 (10.0) |
| Systemic infection | 10 (10.4) | 4 (10.0) |
* ) indicates pathogenetic factors documented in #/96 patients (numbers in parentheses are percentages per 96 patients)
$ ) indicates postulated factors in 40 literature reports (numbers in parentheses are percentages per 40 reports)
#) DRI dietary reference intake (age-adapted)