Background

Bezoars are lumps that develop in an animal’s digestive system including humans. They are associated with several therapeutic benefits in the past.  

The indigestible items build up on non the gastrointestinal tract and mix with bile, mucus, and other digestive fluids to produce a solid mass. 

It is categorized based on their composition. Trichobezoars are made of hair and are frequently observed in people who have obsessive eating or hair pulling behaviors.  

Undigested plant material that are frequently linked to high-fiber diets that include fruits and vegetables. 

Epidemiology

Certain populations may have a higher prevalence than others, such as those with psychiatric illnesses or prior gastrointestinal procedures. 

Bezoars can affect people of any age, though some varieties might be more common age ranges.  

Depending on local food and cultural traditions there are certain bezoar species that may be common. 

Anatomy

Pathophysiology

Bezoars are composed of a mixture of mucus, stomach acid, and other digestive fluids then it combined with items that have been consumed for e.g., hair, fibers, seeds, drugs, or other foreign objects.  

The components that are consumed and the underlying causes of bezoar affect its composition. Depending on their size, location, and bezoars can result in a range of gastrointestinal symptoms and consequences. 

The GI tract is obstructed due to symptoms like nausea, bloating, constipation, vomiting, and abdominal discomfort. 

Etiology

Indigestible materials gather and collect within the GI tract to generate bezoars. People suffering from conditions which impair their stomach motility may be more susceptible to developing bezoars.  

In diseases like gastroparesis, it states that reduced stomach motility can cause problems with digestion. Hence the emptying of ingested materials, which raises the possibility of bezoar development. 

Dietary practices and composition can affect the development of bezoars. High-fiber diets, including fruits, vegetables, or other plant-based meals increases the risk of development of phytobezoars. 

Genetics

Prognostic Factors

The prognosis may be affected by the bezoar’s size and positioning within the digestive system.  

Greater bezoars may increase the risk of consequences such intestinal perforation or ischemia by raising the possibility of total or partial obstruction. 

The development of complications, such as gastrointestinal obstruction, ulceration, perforation, or sepsis, can significantly impact prognosis. Complicated cases may require more aggressive treatment approaches and have a higher risk of morbidity and mortality. 

Clinical History

Age Group:  

Infants are more likely to have lactobezoars, which are made of undigested milk curds. 

The intake and accumulation of hair causes trichobezoars, which are more common in teenagers and young adults. 

 Age-related changes in the motility and function of the gastrointestinal tract may put older persons at higher risk of acquiring bezoars.  

Associated Comorbidity or Activity:   

Compulsive hair-pulling disorder is strongly associated with the development of trichobezoars, which are composed of ingested hair.  

Delayed gastric emptying, as seen in gastroparesis, can predispose individuals to bezoar formation by allowing ingested material to accumulate and collect within the stomach. 

Individuals with developmental disabilities or neurological disorders may exhibit behaviours. 

Acuity of Presentation:  

Individuals with bezoars may experience chronic or recurrent symptoms related to gastrointestinal dysfunction.  

Large bezoars or those located in critical areas of the gastrointestinal tract can cause acute mechanical obstruction.  

Bezoars particularly those with sharp or abrasive components it can degrade the gastrointestinal mucosa and lead to bleeding.  

Physical Examination

• Abdominal Examination: Gentle palpation of the abdomen may reveal areas of tenderness, distension, or palpable masses suggestive of a bezoar. 
• Signs of Dehydration: Assessment of signs of dehydration, such as dry mucous membranes, decreased skin turgor, sunken eyes, or reduced urine output is important. 
• Rectal Examination: Digital rectal examination may be performed to assess for the presence of fecal impaction or evidence of rectal bleeding, which may be associated with bezoars causing obstruction or mucosal injury. 
• Skin Examination: In cases of trichobezoars examination of the scalp and hair may reveal evidence of trichotillomania or alopecia in individuals predisposed to this condition. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

• Gastric Ulcer: Peptic ulcers, including gastric ulcers and duodenal ulcers, can cause symptoms such as epigastric pain, nausea, vomiting, and signs of gastrointestinal bleeding. 
• Gastroesophageal Reflux Disease (GERD): GERD can present with symptoms such as heartburn, regurgitation, chest pain, or difficulty swallowing, which may overlap with symptoms of bezoars. 
• Gastroparesis: Gastroparesis, characterized by delayed gastric emptying, can cause symptoms like those of bezoars, including bloating, nausea, vomiting, and abdominal discomfort. 
• Bowel Obstruction: Conditions causing bowel obstruction in the small intestine or colon, such as adhesions, tumors, volvulus, or diverticulitis, may present with symptoms. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Dietary Modifications: In cases of phytobezoars, dietary modifications such as increasing fluid intake and consuming foods with lower fiber content may help promote bezoar dissolution and passage. 
• Enzyme Therapy: Oral administration of enzymes such as cellulase or papain may help in the dissolution of phytobezoars by breaking down plant fibers. 
• Behavioral Therapy: Patients with underlying psychiatric disorders such as trichotillomania, pica, or eating disorders may benefit from behavioral therapy, counseling, or psychiatric medications to address the underlying psychological factors contributing to bezoar formation. 
• Nutritional Support: Nutritional assessment and support may be necessary in patients with bezoars associated with malnutrition or eating disorders to address deficiencies and promote healthy eating habits. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-bezoars

• Dietary Modifications: Encourage a well-balanced diet rich in fruits, vegetables, and whole grains while ensuring adequate hydration. Educate individuals about proper chewing habits to aid digestion and prevent the accumulation of undigested food particles. 

• Behavioral Interventions: Promote healthy eating behaviors, mindful eating practices, and stress management techniques to reduce the risk of compulsive or maladaptive eating habits. 
• Hydration and Physical Activity: Encourage adequate hydration and regular physical activity to promote gastrointestinal motility and prevent constipation, which can contribute to bezoar formation. 
• Monitoring and Follow-up: Regular monitoring and follow-up with healthcare providers are important to assess treatment effectiveness, monitor for complications, and prevent recurrence of bezoars. 

Use of Prokinetic Agents

• Metoclopramide: Metoclopramide is a prokinetic agent that enhances gastrointestinal motility by stimulating the release of acetylcholine and inhibiting dopamine receptors in the gastrointestinal tract. It may use to improve gastric emptying and facilitate the passage of bezoars, particularly in cases of gastroparesis or delayed gastric transit. 

Role of Mucolytic Agents

• N-Acetylcysteine (NAC): NAC is a mucolytic agent that can break down the protein matrix of certain types of bezoars, such as trichobezoars composed of hair. It works by cleaving disulfide bonds within the protein structure, making the bezoar more flexible to dissolution or fragmentation. 

use-of-intervention-with-a-procedure-in-treating-bezoars

• Endoscopic Removal: Endoscopic removal is indicated for bezoars located in the esophagus, stomach, or upper gastrointestinal tract that are amenable to endoscopic access. 
• Laparoscopic Gastric Lavage: Laparoscopic gastric lavage may be considered as an adjunctive procedure to facilitate the removal or dissolution of bezoars. 
• Surgical Removal: Surgical removal is indicated for large or impacted bezoars that cannot be safely managed with conservative or endoscopic measures, or in cases of complications such as perforation or peritonitis. 

use-of-phases-in-managing-bezoars

• Initial Assessment and Diagnosis: The management process begins with a thorough clinical evaluation, including a detailed history and physical examination, to assess symptoms, identify risk factors, and determine the need for further investigation. 
• Acute Intervention: In cases of acute presentation with symptoms such as severe abdominal pain, vomiting, or signs of gastrointestinal obstruction or perforation, immediate intervention may be required to stabilize the patient and address urgent complications. 
• Interventional Procedures: Procedural interventions, such as endoscopic removal, endoscopic dissolution, or surgical removal, may be performed to address the bezoar directly and alleviate symptoms. 
• Medical Management: Pharmacological therapies may be used to facilitate bezoar dissolution or passage, address underlying comorbidities, and prevent recurrence. 

Medication

Future Trends

Media Gallary

References

Review of the diagnosis and management of gastrointestinal bezoars – PMC (nih.gov) 

Gastrointestinal Bezoars: History and Current Treatment Paradigms – PMC (nih.gov)