Bezoars

Bezoars are masses composed of indigestible material that accumulate within the gastrointestinal tract, most often in the stomach but sometimes in the small intestine. They can cause obstruction or other complications and may present with abdominal pain, fullness, nausea, vomiting, or weight loss. Bezoars occur in humans and, less commonly, in animals.

Bezoars are classified by their composition: phytobezoars (plant fibers, skins, fruit and vegetable matter; often from persimmons or cellulose-rich foods), trichobezoars (hair; associated with trichotillomania and pica), pharmacobezoars (medications that do not dissolve; e.g., extended-release formulations), and lactobezoars (formula or milk curds in infants).

Etiology and risk factors include prior gastric surgery or motility disorders (gastroparesis), excessive intake of high-fiber foods without adequate chewing, poor dentition, dehydration, and psychiatric conditions such as trichotillomania and pica.

Diagnosis is via imaging and endoscopy: CT is highly sensitive for detecting masses and obstruction; ultrasound can show intraluminal echogenic masses; endoscopy both diagnoses and sometimes allows mechanical fragmentation or removal.

Treatment depends on size, type, and location. Small phytobezoars may respond to endoscopic fragmentation and, in selected cases, dissolution with enzymatic agents or Coca-Cola lavage; pharmacobezoars may require altering or stopping offending medications. Larger bezoars or those causing obstruction usually require endoscopic removal or surgical extraction; Rapunzel syndrome (bezoar extending into the small intestine) typically requires surgery. After removal, addressing underlying causes (e.g., gastric motility issues, psychiatric conditions, dietary modification) is important to prevent recurrence.

Bezoars are usually treatable, with prognosis favorable when promptly diagnosed and managed; however, complications such as obstruction, ulceration, or perforation can occur.

Etymology: the term bezoar derives from Persian and Arabic words historically referring to a universal antidote.