A bezoar is a compacted mass of undigested or partially digested material found within the gastrointestinal tract. While small bezoars might occasionally pass naturally, it is generally uncommon for significant bezoars to pass entirely on their own. This article discusses what bezoars are, their types, factors influencing their passage, associated symptoms, and medical management.
Understanding Bezoars
Bezoars are masses of foreign, indigestible material that accumulate in the digestive system. While they can form anywhere, the stomach is their most frequent location. They vary in composition, leading to different classifications. Phytobezoars, the most common type, consist of indigestible plant fibers from fruits and vegetables, such as cellulose, hemicellulose, and lignin. Foods like persimmons, celery, prunes, and raisins are common culprits. Trichobezoars are composed of hair or hair-like fibers, often seen in individuals who ingest their own hair, sometimes linked to psychiatric conditions. Lactobezoars are masses of milk protein, typically found in infants, especially those who are premature and fed highly concentrated formulas. Pharmacobezoars form from undissolved medications, particularly extended-release formulations. Bezoar formation is often linked to reduced gastric acidity, impaired gastrointestinal motility, or prior gastric surgeries that affect stomach emptying.
The Likelihood of Natural Passage
While the digestive system processes food and eliminates waste, natural passage of a bezoar is infrequent, especially for larger or denser masses. Small, soft bezoars might occasionally pass without intervention, but most clinically significant bezoars require medical assistance. Several factors influence natural passage. The bezoar’s size is a primary determinant; larger masses are less likely to navigate the intestines. Composition also plays a role, as softer phytobezoars may fragment more easily than dense trichobezoars or pharmacobezoars. The bezoar’s shape and an individual’s gastrointestinal motility, or the muscular contractions that move contents through the digestive tract, also impact spontaneous passage.
Signs and Complications
When a bezoar does not pass naturally, it can cause various symptoms. Common indicators include abdominal pain, nausea, and vomiting, as the mass can obstruct digested material flow. Individuals might also experience early fullness, weight loss, or malnutrition. If untreated, bezoars can lead to serious complications. Gastrointestinal obstruction is a significant concern, where the mass blocks the digestive tract, causing severe pain and inability to pass stool or gas. Bezoars can also pressure the stomach or intestinal lining, potentially leading to ulcers, bleeding, or perforation, a tear in the bowel wall that allows contents to leak into the abdominal cavity.
Medical Management
Diagnosing a bezoar involves imaging studies like X-rays, ultrasound, or computed tomography (CT) scans to visualize the mass. Endoscopy, which involves inserting a flexible tube with a camera down the throat, allows direct visualization of the bezoar, enabling medical professionals to assess its characteristics and sometimes even begin the removal process. Treatment approaches vary depending on the bezoar’s type, size, and location. For some phytobezoars, dietary modifications or enzyme dissolution agents, such as cellulase or papain, may be used to help break down the mass. Endoscopic removal is a common method, where specialized tools fragment the bezoar into smaller pieces for retrieval or natural passage. If the bezoar is too large or dense for endoscopic removal, or if complications like obstruction or perforation have occurred, surgical intervention may be necessary.