Bezoars

A bezoar is a packed collection of ingested foreign objects such as hair or fiber that forms in the stomach and fails to pass through the intestines. ^[1] It can lodge anywhere but most common locations are stomach, esophagus and upper intestines. Most cases are not fatal but bezoars can cause considerable pain when there is subsequent obstruction. Other digestive problems may also take place when prompt medical attention is not given. ^[2]

Epidemiology

Bezoar is often noted in people with irregular gastric emptying particularly patients with diabetic gastroparesis and those who had gastric surgery. ^[3] Mentally retarded and emotionally disturbed children have greater risk. Bezoars are also usually seen in females 10 to 19 years of age. ^[1]

Causes

Chewing or eating indigestible materials like plastic can cause the formation of bezoar. Chewing on or eating hair is a frequent cause. ^[4] A bulk of ingested hair called trichobezoar is often seen in children and young individuals. In some cases, ingested seeds, pills and vegetable husks lead to development of bezoar. The most common bezoar found in adults is phytobezoar and is usually made of vegetable matter. An atypical type called diospyrobezoar develops in people who eat unripe or unpeeled persimmon fruits. ^[5]

Signs and Symptoms

Most affected individuals are asymptomatic. In some cases, they manifest with epigastric pain, nausea, bad breath, gastric ulcers, weight loss and upper gastrointestinal bleeding. ^[5] While some bezoars induce vomiting, some may cause inability to vomit. ^{[4] [2]} Bezoars may become fragmented with some of the portions blocking the digestive tract and causing bowel obstruction. ^[5]

Diagnosis

History of the patient will be obtained. During physical examination, an abdominal lump may be felt. The diagnosis is often done through upper GI endoscopy or radiologic imaging such as barium swallow x-ray.  The radiologic image may show a mass in the gastrointestinal tract which can be viewed directly using an endoscope. ^[4]

Treatment

Usual treatment procedure is endoscopic fragmentation while trichobezoars are often removed by surgery.  Special endoscopic tools are used in extremely hard bezoars. Some of these tools are bezotomes, lithotriptors and lasers. Gastric lavage with Coca Cola and direct injection of Coca Cola are reported to be safe and effective procedures for bezoars. ^[5]

References:

1 http://www.nlm.nih.gov/medlineplus/ency/article/001582.htm

2. http://www.wisegeek.com/what-are-bezoars.htm

3.http://www.merckmanuals.com/professional/gastrointestinal_disorders/bezoars_and_foreign_bodies/bezoars.html

4. http://health.nytimes.com/health/guides/disease/bezoar/overview.html

5. http://www.gastrosource.com/Patient-Cases/Dr.Kruse/1384893?itemId=1384893