Bezoar

A bezoar is a mass of indigestible material that accumulates in the gastrointestinal tract, most often in the stomach. Bezoars can be composed of hair (trichobezoar), plant fibers (phytobezoar), medications (pharmacobezoar), or ingested inorganic material such as stones (lithobezoar). In the past, bezoars were valued for supposed medicinal properties and were believed to act as antidotes to poisons.

Phytobezoars form from indigestible plant materials, including cellulose, fruit seeds, and tannin-rich fruits such as persimmons, especially in individuals with reduced gastric motility or after gastric surgery. Trichobezoars are collections of ingested hair, often occurring in young people with trichophagia and may extend into the small intestine (Rapunzel syndrome). Pharmacobezoars arise from certain medications that aggregate or do not dissolve. Lithobezoars consist of ingested stones or grit.

Symptoms are nonspecific and may include early satiety, abdominal fullness, nausea, vomiting, abdominal pain, or weight loss. Complications can include gastric ulcers, obstruction, or perforation. Diagnosis typically relies on endoscopy, which can visualize and sometimes treat the bezoar, supported by imaging such as CT or ultrasound. Bezoars may be radiolucent on plain X-ray; CT is often diagnostic.

Treatment ranges from endoscopic fragmentation and retrieval to chemical dissolution for phytobezoars (for example, with cola therapy or enzymatic agents) and surgical removal for large or refractory cases. Rapunzel syndrome requires surgical management. Prevention focuses on treating underlying motility disorders, dietary modification, and addressing psychiatric conditions in cases of trichobezoars to reduce recurrence.