Foods high in fiber and phytobezoar formation.

High-fiber diets are being recommended by government agencies, cancer institutes, and manufacturers of high-fiber foods. Although this recommendation is appropriate for the majority of clients, some persons are prone to form phytobezoars and should not add certain kinds of fiber to the diet. The phytobezoar is a compact mass of fibers, skins, seeds, leaves, roots, or stems of plants that collects in the stomach or small intestine. Other food particles, such as fats, crystals, granules, fibers, and residues of salts, are incorporated into the mass and contribute to the growth of the bezoar. Clients who have undergone surgical procedures for peptic ulcer disease or stomach cancer or who for other reasons, such as diabetic gastroparesis, have a loss of normal pyloric function and decreased gastric acidity are prone to form phytobezoars. Once formed, the bezoar can be disintegrated through surgery, by the use of the Water Pik and enzymes during endoscopy, or by treatment with metoclopramide. The dietitian should advise such clients to avoid identified foods that lead to phytobezoar formation--oranges, persimmons, coconuts, berries, green beans, figs, apples, sauerkraut, brussels sprouts, and potato peel.