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Bezoar: Causes, Symptoms and Treatment
A bezoar is a compact mass of indigestible material that accumulates in the stomach or intestines. It can cause symptoms such as nausea, vomiting, and abdominal pain.
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A bezoar is a compact mass of indigestible material that accumulates in the stomach or intestines. It can cause symptoms such as nausea, vomiting, and abdominal pain.
What Is a Bezoar?
A bezoar is a solid, often ball-shaped mass of indigestible material that forms and becomes trapped in the gastrointestinal tract, most commonly in the stomach. The term derives from Arabic and Persian, roughly meaning “antidote” – in the Middle Ages, animal-derived bezoars were believed to have healing and protective properties. In modern medicine, however, a bezoar is considered a pathological finding that may require medical treatment.
Types of Bezoars
- Phytobezoar: The most common type; composed of undigested plant material such as fibers, skins, or seeds. Frequently associated with consumption of persimmons or other high-fiber foods.
- Trichobezoar: Formed from swallowed hair. Most often seen in young women or girls with trichotillomania (compulsive hair-pulling and swallowing).
- Lactobezoar: Composed of thickened milk formula, primarily occurring in premature infants or neonates receiving high-calorie feeds.
- Pharmacobezoar: An accumulation of undigested medications or their components, often associated with extended-release tablet formulations.
- Haematobezoar: A rare form consisting of clotted blood in the stomach.
Causes and Risk Factors
Bezoars form when the stomach is unable to fully process or expel indigestible substances. Key risk factors include:
- Delayed gastric emptying (gastroparesis), commonly seen in patients with diabetes mellitus
- Prior gastric surgery (e.g., partial gastrectomy or vagotomy)
- Reduced stomach acid production (achlorhydria)
- Poor dentition or chewing difficulties
- Psychiatric conditions such as trichotillomania or pica syndrome (compulsive ingestion of non-food substances)
- Long-term use of certain medications
- Excessive consumption of hard-to-digest foods
Symptoms
Small bezoars may remain asymptomatic. Larger masses, however, often cause:
- Nausea and vomiting
- Abdominal pain or pressure sensation in the upper abdomen
- Early satiety (feeling full quickly)
- Weight loss and decreased appetite
- A visible or palpable abdominal mass
- In severe cases: intestinal obstruction (ileus), gastrointestinal bleeding, or perforation
Diagnosis
Bezoars are diagnosed using several investigative methods:
- Endoscopy (gastroscopy): The gold standard; allows direct visualization and simultaneous therapeutic intervention.
- Computed tomography (CT scan): Useful when an intestinal bezoar or complications are suspected.
- Ultrasound: Can reveal a bezoar as an echogenic mass with posterior acoustic shadowing.
- X-ray: Less specific but may provide initial diagnostic clues.
Treatment
Treatment depends on the size, type, and location of the bezoar, as well as the overall health of the patient:
Conservative Treatment
For phytobezoars, oral administration of Coca-Cola (low-sodium variety) or other carbonated beverages can soften and dissolve the mass. Enzymatic agents such as cellulase or mucolytic agents like N-acetylcysteine may also be used for chemical dissolution. Prokinetic drugs such as metoclopramide can help improve gastric motility.
Endoscopic Treatment
When dissolution is not effective, a gastroenterologist can mechanically fragment and remove the bezoar during an endoscopic procedure using specialized grasping or snare instruments.
Surgical Treatment
Large bezoars that cannot be managed endoscopically, or those complicated by intestinal obstruction or perforation, require surgical removal.
Prevention
To reduce the risk of bezoar formation:
- Chew food thoroughly before swallowing
- Avoid excessive intake of high-fiber or hard-to-digest foods, especially in individuals with known gastric motility disorders
- Undergo regular medical follow-up after gastric surgery
- Seek psychological support for trichotillomania or pica syndrome
References
- Iwamuro M. et al. - Review of the diagnosis and management of gastrointestinal bezoars. World Journal of Gastrointestinal Endoscopy, 2015.
- Ripollés T. et al. - Gastrointestinal bezoars: sonographic and CT characteristics. American Journal of Roentgenology, 2001.
- Ladas S.D. et al. - Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Alimentary Pharmacology & Therapeutics, 2013.
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