Persimmon Consumption and Bezoar Risk
Yes, persimmon consumption can cause bezoars (phytobezoars/diospyrobezoars), particularly in patients with prior gastric surgery, reduced gastric motility, loss of pyloric function, or hypoacidity. 1
Mechanism and Risk Factors
Persimmons contain high concentrations of tannins that polymerize in acidic gastric environments, forming hard, indigestible masses called diospyrobezoars. 2, 3 These are notably harder and more difficult to dissolve than other phytobezoars. 3
High-risk populations include:
- Patients with prior gastric surgery (vagotomy, pyloroplasty, gastric bypass, sleeve gastrectomy) 1, 4, 5
- Individuals with reduced gastric motility or hypoacidity 1
- Patients with loss of pyloric function 1
- Older adults (advanced age is an independent risk factor) 2
- Those with poor mastication habits 1
Clinical Evidence
In a surgical series of 113 patients with persimmon phytobezoars over 3 years, 105 had undergone previous gastric operations, demonstrating the strong association with altered gastric anatomy. 4 Even without traditional risk factors, excessive consumption (as little as 2-3 persimmons weekly or 2 daily) can cause bezoar formation. 2, 5
Prevention Strategy
Patients who have undergone bariatric or gastric surgery should be explicitly counseled to avoid persimmon consumption entirely. 1 The 2017 Advances in Nutrition guidelines specifically recommend avoiding "citrus pith and persimmons" after bariatric surgery, emphasizing dietary counseling on bezoar formation and prevention. 1
For the general population:
- Limit persimmon intake, particularly unripe persimmons with higher tannin content 2
- Ensure thorough chewing (at least 15 times per bite) 6
- Avoid consuming persimmons on an empty stomach 5
Clinical Presentation
Typical manifestations include nausea, vomiting, abdominal pain, anorexia, and signs of gastric outlet or small bowel obstruction. 4, 2 Physical findings may include elevated temperature, leukocytosis, and decreased bowel sounds. 4
Common Pitfall
The most critical error is failing to obtain a detailed dietary history in patients presenting with gastric or intestinal obstruction, particularly those with prior gastric surgery. 2, 5 Diospyrobezoars can be mistaken for food debris on CT imaging due to similar density, making diagnosis challenging without considering the clinical context. 7