Masses of undigestible materials can get stuck in the stomach.
Most bezoars cause no symptoms.
The diagnosis is based on x-rays and other imaging tests and on a visual examination of the digestive tract using endoscopy.
Most bezoars need to be broken up into pieces with instruments or with swallowed agents or removed using an endoscope or surgically.
The stomach is a common collection site for hardened, partially digested or undigested masses of material called bezoars. Bezoars cannot pass through narrow openings or spaces and thus may get stuck in the digestive tract. Bezoars accumulate most often in the stomach but sometimes elsewhere in the digestive tract. Bezoars larger than ¾ of an inch (about 2 centimeters) in diameter are rarely able to pass out of the stomach because of the narrow opening (pyloric sphincter) that the stomach's contents must pass through to enter the first segment of the small intestine (duodenum).
There are several types of bezoars. Bezoars are classified according to what they are made of:
Phytobezoars are most common and are made of undigestible fruit and vegetable material such as fiber, peels, and seeds.
Diospyrobezoars, a kind of phytobezoar, are made of fruits called persimmons.
Trichobezoars are made of partially digested hair.
Pharmacobezoars are made of hardened blocks of medications (such as antacids).
Lactobezoars are made of milk protein and can occur in infants who are fed milk.
Bezoars can also be made of a variety of other substances including tissue paper and polystyrene foam products (such as cups).
Risk factors for bezoars
Food or other materials can collect in anyone, including children, but are more likely to collect in people who have certain risk factors.
General risk factors include
Having had surgery on the digestive tract, particularly procedures that involve removing part of the stomach or intestines (for example, surgery for peptic ulcer disease Treatment A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from infection with Helicobacter... read more and surgery for obesity Bariatric Surgery Bariatric (weight-loss) surgery alters the stomach, intestine, or both to produce weight loss. In the United States, about 160,000 people have bariatric surgery each year. This number accounts... read more )
Disorders that keep the stomach from emptying of food appropriately (for example, diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more , certain autoimmune disorders Overview of Autoimmune Disorders of Connective Tissue In an autoimmune disorder, antibodies or cells produced by the body attack the body’s own tissues. Many autoimmune disorders affect connective tissue and a variety of organs. Connective tissue... read more , and mixed connective tissue disease Mixed Connective Tissue Disease (MCTD) Mixed connective tissue disease is a term used by some doctors to describe a disorder characterized by features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. Raynaud... read more )
Taking certain medications or drugs that slow stomach contractions
Risk factors more common among older people include
Poorly fitting dentures
Not chewing food completely
Having a low level of stomach acid (hypochlorhydria)
Trichobezoars most commonly occur in young females who have mental health disorders who chew and swallow their own hair.
Symptoms of Bezoars
Most bezoars do not completely block the digestive tract and thus cause no symptoms. However, people may feel very full after eating a normal-sized meal and may have nausea, vomiting, and pain. People may also lose their appetite and lose weight.
Complications of bezoars
Sometimes bezoars disrupt the lining of the gastrointestinal tract and cause bleeding, which may appear in the stool (see Gastrointestinal Bleeding Gastrointestinal Bleeding Bleeding may occur anywhere along the digestive (gastrointestinal or GI) tract, from the mouth to the anus. Blood may be easily seen by the naked eye (overt), or blood may be present in amounts... read more ).
If bezoars are partially or completely obstructing the stomach, the small intestine, or, rarely, the large intestine, they may cause cramps, bloating, loss of appetite, nausea, and vomiting (see Intestinal Obstruction Intestinal Obstruction An obstruction of the intestine is a blockage that completely stops or seriously impairs the passage of food, fluid, digestive secretions, and gas through the intestines. The most common causes... read more ). Sometimes bezoars cause intussusception Intussusception Intussusception is a disorder in which one segment of the intestine slides into another, much like the parts of a telescope. The affected segments block the bowel and block blood flow. The cause... read more (where one segment of the intestine slides into another, much like the parts of a telescope) and can block the intestines. If not treated, intussusception sometimes causes part of the intestinal tissue to die.
Bezoars can also rarely cause a perforation of the digestive tract Perforation of the Digestive Tract Any of the hollow digestive organs may become perforated (punctured), which causes a release of intestinal contents and can lead to sepsis (a life-threatening infection of the bloodstream) and... read more . A perforation allows food, digestive juices, or intestinal contents including stool to leak into the abdomen. Such leakage is a medical emergency because it can cause peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more (inflammation of the peritoneal [abdominal] cavity).
Diagnosis of Bezoars
Often, a bezoar can be seen on imaging tests, such as x-rays X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays ( plain x-rays) can show some blockages or paralysis of the digestive tract, or abnormal air patterns in the abdominal cavity... read more , computed tomography Computed Tomography and Magnetic Resonance Imaging of the Digestive Tract Computed tomography (CT) and magnetic resonance imaging (MRI) scans are good tests for assessing the size and location of abdominal organs. Additionally, cancerous (malignant) or noncancerous... read more (CT), and ultrasonography Ultrasound Scanning (Ultrasonography) of the Abdomen Ultrasound scanning uses sound waves to produce pictures of internal organs (see also Ultrasonography). An ultrasound scan can show the size and shape of many organs, such as the liver and pancreas... read more , of the abdomen.
Usually, endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more (a visual examination of the digestive tract using a flexible tube called an endoscope) is done to confirm the diagnosis of a bezoar and to exclude a tumor as the cause. During the endoscopy, doctors may remove a piece of a bezoar and examine it under a microscope to see what it is made of, such as hair or plant material. Doctors may try to break the bezoar into pieces and remove it during endoscopy.
Treatment of Bezoars
Measures to dissolve the bezoar
To help break down and dissolve a bezoar, a doctor may prescribe cola or cellulase for people who have mild symptoms. Cellulase is dissolved in water and taken by mouth for 2 to 5 days. Doctors may also give another medication taken by mouth called metoclopramide. This medication stimulates the movement of contents through the stomach and intestines.
If the bezoar does not dissolve or if people have moderate to severe symptoms, doctors can try to remove the bezoar by doing endoscopy.
During endoscopy, doctors sometimes use forceps, a laser, or other instruments to break bezoars into pieces so that they can pass through or be removed more easily.
Bezoars that are hard as rocks (such as those made of persimmons) usually need to be removed surgically.