Bezoars

Phytobezoars can occur in adult patients as a postoperative complication after gastric bypass or partial gastrectomy, especially when partial gastrectomy is accompanied by vagotomy.

Trichobezoars most commonly occur in young females with psychiatric disorders who chew and swallow their own hair.

Lactobezoars can occur in milk-fed infants.

Delayed gastric emptying due to diabetes mellitus Diabetes Mellitus (DM) Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia... read more , mixed connective tissue disease Mixed Connective Tissue Disease (MCTD) Mixed connective tissue disease is an uncommon, specifically defined syndrome characterized by clinical features of systemic lupus erythematosus, systemic sclerosis, and polymyositis with very... read more , other systemic illness, or drugs increases the risk of gastric bezoar formation.

Other predisposing factors include hypochlorhydria, diminished antral motility, and incomplete mastication; these factors are more common among older people, who are thus at higher risk of bezoar formation.

Gastric bezoars are usually asymptomatic. When symptoms are present, the most common include postprandial fullness, abdominal pain, nausea, vomiting, anorexia, and weight loss.

Bezoars are detectable as a mass lesion on imaging studies (eg, x-ray, ultrasound, CT) that are often done to evaluate the patient's nonspecific upper gastrointestinal symptoms. The findings may be mistaken for tumors.

Upper endoscopy is usually done to confirm the diagnosis. On endoscopy, bezoars have an unmistakable irregular surface and may range in color from yellow-green to gray-black. An endoscopic biopsy that yields hair or plant material is diagnostic.

The optimal therapeutic intervention is controversial because randomized controlled trials comparing different options have not been done. Sometimes, combination therapy is required.

Chemical dissolution using agents such as cola and cellulase can be done for patients with mild symptoms (1 Treatment references A bezoar is a tightly packed collection of partially digested or undigested material that most commonly occurs in the stomach. Gastric bezoars can occur in all age groups and often occur in... read more ). Cellulase dosage is 3 to 5 g dissolved in 300 to 500 mL of water; this is taken over the course of a day for 2 to 5 days. Metoclopramide 10 mg orally is often given as an adjunct to promote gastric motility. Enzymatic digestion using papain is no longer recommended.

Endoscopic removal is indicated for patients who have bezoars that fail to dissolve, moderate to severe symptoms due to large bezoars, or both. If initial diagnosis is made by endoscopy, removal can be attempted at that time. Fragmentation with forceps, wire snare, jet spray, argon plasma coagulation, or even laser (2 Treatment references A bezoar is a tightly packed collection of partially digested or undigested material that most commonly occurs in the stomach. Gastric bezoars can occur in all age groups and often occur in... read more ) may break up bezoars, allowing them to pass or be extracted.

Surgery is reserved for cases in which chemical dissolution and endoscopic intervention cannot be done or have failed, for patients with complications, or for patients with intestinal bezoars.

Persimmon fruit bezoars are usually hard and difficult to treat because persimmons contain the tannin shibuol, which polymerizes in the stomach. They do not respond well to chemical dissolution and usually require endoscopic or surgical removal.