Case series / case reportindependent cross-checkabstract checked I-GUT-119 in-depth review
Food-ball blockages are rare and need special risk factors
Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography.
Overview
Wang PY et al.. World J Gastroenterol 2015 · PMID 26361425 · DOI 10.3748/wjg.v21.i33.9774
Among 35 people with bowel blockage from food balls, most had eaten lots of persimmons, half had previous stomach surgery and half had missing back teeth.
Does the study support the specific claim? Partly · Methodological quality: very low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Describe food-ball bowel obstructions.
- How was the study done?
Retrospective case series.
- How many people, animals or samples were studied?
35 surgical patients in China.
- What was actually found?
Persimmon/hawthorn, prior surgery and missing teeth were common.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Very rare; mostly in people with specific risk factors.
- What are the study's limitations?
No comparison group.
- What does it say about Elawady's specific claim?
Gives limited support in rare groups; not for healthy people.
- Do the results apply to Germany and Europe?
Low relevance to Europe.
- What can explicitly not be concluded from this study?
Cannot estimate how often poor chewing causes obstruction.
Scientific in-depth review
1. Full reference
- Authors
- Wang PY et al.
- Journal
- World J Gastroenterol
- Year
- 2015
- Identifier
- PMID 26361425 DOI 10.3748/wjg.v21.i33.9774
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract
2. Research question
What are the predisposing factors and CT features of bezoar-induced small bowel obstruction?
3. Study design and population
- Study design
- Case series / case report – Retrospective case series of surgically confirmed bezoar small bowel obstruction
- Population
35 patients with surgically confirmed bezoar SBO in one Chinese hospital
- Country
China
- Period
2007-2013
- Sample size
35
- Inclusion and exclusion criteria
Surgically confirmed bezoar SBO with complete CT data
4. Methods and endpoints
- Exposure / intervention
Predisposing factors
- Comparator
None
- Endpoints
Clinical characteristics; CT features
- Statistical methods
Descriptive
5. Actual results
- Results
29 (82.8%) occurred in autumn/winter with high persimmon or hawthorn intake; 19 (54.3%) had prior GI surgery; 19 had incomplete dentition (missing posterior teeth); 26 obstructed at the ileum.
- Absolute risks
Not applicable
- Authors' conclusion
Bezoar SBO shows regional and seasonal characteristics; CT is useful.
6. Strengths
- Surgically confirmed cases
7. Weaknesses
- No control group
- Small, single centre
- Highly selected
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Case series cannot estimate risk.
9. Assessment of the statistical interpretation
No risk estimate possible.
10. Relevance to the specific claim
Shows a limited kernel: in rare cases, poor dentition plus specific fibrous foods (persimmon) and prior surgery contribute to bezoar obstruction; not a general consequence of imperfect chewing.
11. Independent contrary findings
Bezoars are found in <0.5% of gastroscopies (I-INTC-08).
12. Transferability to Germany and Europe
Low; persimmon/hawthorn-related.
13. Overall methodological judgement
Conditional, rare risk only.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | very low |
| Risk of bias | high |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Population risk of obstruction by chewing ability.
15. Linked fact checks
- Food that is not chewed well is not fully digested in the stomach, and this incomplete digestion leads to intestinal obstruction. – Studies with mixed or unclear results
- Hard-to-digest foods (for example two spoons of flour) cause repeated, incomplete intestinal obstructions lasting days, which drive insulin 'sky-high' and cause obesity and inflammation. – Studies contradicting or limiting the claim