A bezoar refers to a collection of partially digested material that collects in the stomach. Bezoars occur in both humans and animals. Sometimes the material is not digested at all and tightly packages itself in the digestive tract. This causes a blockage in the stomach or intestines.
Many bezoars are asymptomatic, but some cause symptoms and require medical treatment.
Types of Bezoars
Bezoars fall into various categories depending on their composition:
- Lactobezoars come from milk protein and mucus. They can occur in milk-fed infants.
- Foreign body bezoars form from parasitic worms, plastic, paper, and polystyrene foam cups.
- Phytobezoars comprise indigestible food fibers like cellulose. These types of fibers are common in fruits and vegetables. Examples are pumpkin, celery, prunes, beets, leeks, raisins, and sunflower seed shells. This is the most common type of bezoar.
- Trichobezoars comprise hair-like fibers that look like clothing fibers. In extreme cases, the compacted fibers fill the stomach and form a tail that extends to the intestines. The condition is known as Rapunzel's syndrome and mostly affects adolescent girls. It may also affect you if you have developmental disabilities or psychiatric illness.
- Pharmacobezoars are another type that forms from medications that don't properly dissolve in the digestive tract. Most of these medications contain aluminum hydroxide gel and sucralfate.
- Diospyrobezoars form from persimmon fruit.
Causes and Risk Factors of Bezoars
The biggest factor in the formation of bezoars is the buildup of material in the digestive tract. Most of these materials are not digestible by the stomach. Bezoars can form in your digestive system at any age. You are especially at risk if you have:
- Behavior disorders
- Altered gastrointestinal anatomy
- Diabetes or end-stage kidney disease
- Respiratory problems and breathe through mechanical ventilation
- Abnormal gastric emptying
- Reduced stomach acid or stomach size
- The habit of taking excessive amounts of fibers
- Problems in chewing food because of poorly fitted dentures or lack of teeth
- A condition that makes you take certain drugs that slow the process of contraction in the stomach
If you don't have any of these risk factors, it's unlikely that you'll develop a bezoar. However, if you are at risk, reduce your intake of indigestible cellulose to lower your chances of developing one.
Symptoms and Complications of Bezoars
Most bezoar types show no signs or symptoms because they don’t completely block the gastrointestinal tract. In cases where symptoms appear, they include:
- Lack of appetite
- Feeling full after eating a small food portion
- Abdominal pain
- Weight loss
Bezoars can affect the lining of the digestive tract and make it bleed. Sometimes, you may see this blood in your stool. When they partially obstruct the stomach or intestines, bezoars cause cramping and vomiting.
In other cases, bezoars cause one segment of the intestines to slide into another. This can cause blockage, and if left untreated, it may cause part of the intestinal tissue to die. This condition is called intussusception.
In rare situations, bezoars can cause a perforation in the digestive tract. This tear allows food, intestinal contents, including stool, or digestive juices, to leak into the abdomen. This calls for a medical emergency as the condition can lead to inflammation of the abdominal cavity. It presents itself as severe pain in the abdominal cavity, which can radiate to the shoulder. It also increases your heart rate, causes sweating, and makes you very ill.
Diagnosis of Bezoars
Your doctor can diagnose bezoars with these tests:
- Endoscopy: This procedure uses specialized medical tools to view the internal organs and vessels. Doctors can detect bezoars as a mass lesion on imaging studies.
- Abdominal ultrasound: Sound waves capture the internal images and video of your body. They’ll help your doctor see the structure and composition of your abdominal cavity. The method is safe and painless.
- CT scan: Also known as a computed tomography scan or CAT scan, a CT is a form of a specialized X-ray. It shows cross-sectional images of the area of interest in the body.
- X-rays: These abdominal films help the doctor identify potential problems in the stomach, abdominal cavity, or intestines.
In most cases, bezoars will appear as a single mass. In other cases, they will be made up of multiple masses and could be colored green, brown, yellow, or black. The doctor may remove a small piece during an endoscopy to look for plant or hair material.
Treatment of Bezoars
The treatment procedure your doctor uses for bezoars depends on the severity of the condition. If your symptoms are mild, the doctor may recommend some medications to dissolve the bezoar. This will break it up and cause it to pass through your body naturally.
The other alternative is to remove them during an endoscopy during diagnosis. Forceps, lasers, or jet sprays are other methods that may come in handy to remove bezoars. In severe cases, surgery will be necessary to remove the formations.