When a tightly packed mass of undigested or partially digested material builds up in the digestive tract, its known as a bezoar, and it can cause a blockage. Bezoars occur in animals and humans of all age groups and are most commonly found in the stomach. They were once considered to have magical or medicinal properties and that they could provide an effective antidote to poison.
Types of bezoars
There are several types of bezoars. They can be classified by their composition:
- Phytobezoars. These are the most common type of bezoar and are composed of indigestible vegetable fibers.
- Diospyrobezoars. A type of phytobezoar composed of persimmon fruit.
- Trichobezoars. These are composed of hair and food particles and can weigh several kilograms.
- Pharmacobezoars. These are composed of medications that haven’t dissolved.
- Lactobezoars. These are composed of milk protein and mucus.
- Foreign body bezoars. Tissue paper, plastic, polystyrene foam cups, and parasitic worms are other examples of material found in bezoars.
Causes and risk factors
Bezoars are caused by a buildup of material in the gastrointestinal tract that the stomach can’t digest. Although bezoars can affect anyone, some health conditions may indicate an increased likelihood of a bezoar. Phytobozoars most commonly affect people who:
- have had gastric surgery such as a gastric band (for weight loss) or gastric bypass
- have reduced stomach acid (hypochloridia) or decreased stomach size
- have delayed gastric emptying, typically due to diabetes, autoimmune disorders, or mixed connective tissue disease
- can’t or don’t chew their food properly, usually because they have no teeth or poorly fitting dentures
- have an excessive intake of fibers
If you aren’t at risk of bezoars, it’s unlikely that you will develop one. However, for those at risk, reducing the intake of foods with a high level of indigestible cellulose may help to decrease this risk.
Symptoms of bezoars
Most bezoars cause no symptoms because they don’t completely block the digestive tract. Where symptoms do appear, these may include:
- feeling full after eating very little food
- a lack of appetite
- abdominal pain
- weight loss
Bezoars in children
Although older adults are generally at greater risk for phytobezoars, certain types of bezoars are more often found in children. Lactobezoars are the most common type to affect infants.
Risk factors of lactobezoars in infants include:
- prematurity and low birth weight (an immature gastrointestinal tract)
- consumption of high-calorie formula
- addition of thickening agents, such as pectin, to formula
Trichobezoars are usually found in young females who suck, chew, and swallow their own hair. The presence of a trichobezoar may indicate an underlying psychiatric issue.
Your doctor may diagnose you with a bezoar by any of the following tests:
Bezoars are typically observed as a single mass, but they can comprise multiple masses. They may range in color from brown, green, yellow, or even black.
Doctors sometimes try to remove a piece of the bezoar during the endoscopy and examine it under a microscope to look for hair or plant material.
Treatment of bezoars
If a bezoar is detected, there are several options for treatment.
If symptoms are mild, the first step might be to try to dissolve the bezoar so that it can pass through your body naturally or, at least, be broken up and softened so that it may be more easily removed.
Bezoars can also be removed during an endoscopy. This might happen during the diagnosis or after you’ve tried dissolving the bezoar with soda. Forceps, jet sprays, or lasers may also be used to break up or remove bezoars.
Some bezoars, particularly bezoars composed of persimmon, can be more difficult to remove, requiring surgery.
Complications of bezoars
Bezoars, if left untreated, may result in more serious complications. A bezoar may disrupt the lining of your stomach and cause gastric ulcers, bleeding, intestinal damage or perforation, or bowel obstruction.
Outlook and prevention
Treatment of bezoars is largely successful. However, steps should be taken to prevent future occurrences.
Those at increased risk of developing a bezoar may wish to avoid certain foods such as persimmons, celery, pumpkin, prunes, and sunflower seed shells. Chewing food thoroughly before swallowing may also help to prevent their occurrence.
Psychiatric treatment, where appropriate, can help to prevent trichobezoars.