Gastric lactobezoar - a rare disorder?

Gastric lactobezoar (GLB) is a type of acid-insoluble bezoar characterized by its composition of milk and mucus components [1] and localization in the stomach as a free-floating lump. Lactobezoars also differ from other bezoar types such as tricho-, phyto-, mixed food- or medication-bezoars [2] by their almost invariable occurrence during early age, indeed the majority of lactobezoars reported in the literature has been diagnosed in premature neonates [2-5]. While most lactobezoars are located in the stomach, some of them have also been found in the upper [6-8] and lower intestine [9], all of them being manifestations of the inspissated milk syndrome [10]. No genetic associations have been reported so far.This paper summarizes data of 96 patients with GLB from 40 publications identified by searches in PubMed, EMBASE, DIALINDEX, Biosis Previews, CAB Abstracts, Pascal, Sci Search, American Academy of Pediatrics Search Site, JSTOR, LactMed, Lange Case Files, Up To Date, Ovid and Cochrane data bases. Our major purpose is to 1) review the current knowledge about this disorder, 2) alert physicians to the possibility that GLB may be a differential diagnosis of acute abdomen, 3) discuss why GLBs are now so rarely reported, and 4) emphasize early conservative treatment instead of primary endoscopic or surgical interventions.The true prevalence of GLB is unknown. Most of the 96 cases reported were diagnosed in North American Hospitals (USA 76 patients, Canada 1). Additional patients were published by authors from South Africa (4), France (4), UK (4), Austria (3), Germany (1), Israel (1), The Netherlands (1) and Saudi Arabia (1). Of the 51 cases, in whom gender was reported, 22 were females, 29 males. 61 of the 87 patients (70.1%), in whom the age at manifestation of the GLB was documented, were 30 days old or younger. In 20 further patients a GLB became manifest between 31 and 365 days and in 5 toddlers between the age of 440 and 1080 days. We found only 1 publication on a GL