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Table 2 Pathogenetic factors reported/postulated with gastric lactobezoar

From: Gastric lactobezoar - a rare disorder?

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)
  1. * ) indicates pathogenetic factors documented in #/96 patients (numbers in parentheses are percentages per 96 patients)
  2. $ ) indicates postulated factors in 40 literature reports (numbers in parentheses are percentages per 40 reports)
  3. #) DRI dietary reference intake (age-adapted)