World Wide
Have you ever heard of “ Bezoar “ ? What is Bezoar?

What is Bezoar? It is an accumulation of undigested or partially digested substances in any part of the gastrointestinal (GI) tract, which is often the stomach.


 Who are the people with high risk of developing bezoars?


      Patients with altered GI anatomy and motility have a higher risk of developing bezoars, but it can occur in people with normal GI tract, in addition to:

  1. - Patients with partial gastrectomy.

  2. - Decreased stomach volume or low acidity.

  3. - Diabetes mellitus complicated by gastroparesis.

  4. - Any systemic disease may affect GI motility.

  5. - Cystic fibrosis.

  6. - Psychiatric illness.

  7. - Excessive intake of fiber.

  8. - Poor mastication.


What is bezoar

 What are the types of bezoars?

Bezoar types are usually classified according to their materials:

  1. - Phytobezoar: it consists of undigested plant fiber and is considered the most common type ( about 40 % of all types).

  2. - Trichobezoar: or what is called “ Rapunzel Syndrome”, it consists of hair and food particles; this type in particular may reach very large size and may weigh several kilograms. It is usually seen in young females and may indicate an underlying psychological problem.

  3. - Lactobezoar: the most common type in young children, it consists of milk protein and mucus.

  4. - Pharmacobezoar: it consists of medications that are not dissolved in the GI tract.

  5. - Foreign body bezoar: the substances found in it vary widely, for example, plastic ,parasitic worms , tissue paper.

Phytobezoars are usually formed faster than trichobezoars.

What are the symptoms experienced by a patient with bezoar?

      
      Bezoars usually form slowly, so that, they are asymptomatic until they become large or lead to a complication in  the GI tract. Common symptoms :

  • Abdominal pain

  • Nausea

  • Vomiting

  • Early satiety

  • Lack of appetite

       Complications:

  • Ulceration

  • GI bleeding

  • Perforation

  • Gastric outlet obstruction

Therefore , correct diagnosis and prompt treatment is necessary to prevent complications.  

How is bezoar diagnosed?

       The diagnosis of a bezoar involves:

  • Obtaining a thorough patient history ( medications, diet, risk factors)

  • Physical examination : a palpable mass in the abdomen may be observed

  • Halitosis : may indicate the presence of putrefying substance in the stomach

  • Any of the symptoms mentioned above

       Then we move on to imaging to improve the diagnosis:

  1. - Plain abdominal radiograph : may indicate the presence of a bezoar

  2. - Barium studies : useful for identifying bezoars and estimating their size

  3. - Ultrasound.

  4. - Computed tomography (CT) : a reliable method for determining the presence of a bezoar and any additional bezoars with their exact location in the GI tract.

  5. - Endoscopy : is the diagnostic method of choice for gastric bezoars ; it allow visualization and tissue sampling of the bezoar, in addition, it may have therapeutic application.

How is bezoar treated?

       Treatment aims to remove the mass and prevent recurrence. A good measure is to accurately determine the location of the bezoar , then, choose the appropriate method from the following:

  • - Lavage.

  • - Dissolution :studies have been conducted on the use of diet coke and lactulose.

  • - Fragmentation : via endoscopy.

  • - Retrieval.

Whether each method alone or shared together. Surgical removal should be considered in patients who fail medical therapy or who have serious complications. In general, treatment of bezoars is largely successful.

What to do to prevent future occurrence of bezoar?

  • People with risk factors should avoid foods rich in fiber and certain medication.

  • Chew food well before swallowing

  • Correction of underlying motility problems

  • Psychiatric treatment can help to prevent trichobezoars.