Bezoar: Types, Causes & Symptoms
A bezoar is a mass trapped in the digestive tract, such as the stomach, small intestine, or colon. It can be composed of different materials, such as undigested food particles, fiber, hair, or other substances that cause digestive blockages, pressure, and discomfort.
If not managed promptly, bezoars can lead to complications such as obstruction or bleeding. It is crucial to recognize the causes, symptoms, and treatments of bezoars. Understanding how bezoars form and identifying their risk factors is vital for maintaining digestive health.
Types of Bezoars
Bezoars result from accumulating different materials that the body cannot digest. Their compositions can vary widely and are classified into various types based on their components.
Plant-Based Mass Formation
Plant-based bezoars encompass both phytobezoars and diospyrobezoars. Phytobezoars are formed from indigestible plant fibers found in fruits and vegetables. Suppose you consume a large amount without sufficient chewing. In that case, these fibers can compact in your stomach or intestines, leading to blockages.
Diospyrobezoars are formed from the ingestion of persimmons. Consuming in large quantities or when eating this fruit with their skins, the tannins can react with stomach acid, creating a sticky, glue-like substance. This substance clumps with other food particles, forming a solid intestine mass.
Organic Materials
Organic material bezoars include trichobezoars and lactobezoars. Trichobezoars originate from the ingestion of hair, a condition known as trichophagia. Over time, the undigested hair accumulates in the gastrointestinal tract, causing blockages.
Lactobezoars, on the other hand, are formed from milk protein and are commonly seen in infants and young children. This condition arises from consuming large quantities of dairy, particularly formula, leading to the buildup of milk curd in the stomach.
Synthetic and Chemical Bulk
Synthetic and chemical bezoars are comprised of pharmacobezoars and foreign-body bezoars. Pharmacobezoars consist of undissolved medication or drug masses in the gastrointestinal tract. These can form when medications are taken improperly or in large quantities, leading to potential blockages.
Foreign-body bezoars are masses that develop in the digestive tract from ingesting non-food items such as plastic, soap, or paper. Since the digestive system cannot break down these materials, they can build up and cause obstructions, leading to severe gastrointestinal distress and necessitating medical intervention.
Causes and Risk Factors for Bezoars
Various factors can increase your risk of developing bezoars, leading to discomfort and other health issues. Understanding these can help you take preventive measures and seek timely medical attention.
Age
Age significantly influences the risk of developing bezoars. Older adults are particularly susceptible due to decreased digestive efficiency and slowed gastric motility. Aging diminishes the ability to break down and move food, increasing undigested material accumulation. Medical conditions and medications also contribute to setting an environment for bezoar formation.
Infants and young children, particularly those on a milk or formula diet, are also at a higher risk. Their immature digestive systems may struggle to process and break down milk proteins efficiently, leading to the formation of lactobacilli. Their curious nature also contributes to their accidental ingestion of non-food items.
Reduced Stomach Size
A reduced stomach size from naturally occurring conditions can significantly increase the risk of bezoar formation. With a smaller size, food may not mix and break down properly in the stomach, accumulating undigested material as it gets pushed down during meals.
The limited space in a reduced stomach size also means that food passes through more slowly, allowing particles to clump together more easily on the adjacent digestive tract. This can lead to bezoar formation, particularly with a diet high in fibrous foods that are harder to digest.
Digestive Tract Surgery
Surgical procedures on the digestive tract, such as gastric bypass or partial gastrectomy, can lead to complications that increase the risk of bezoar formation. These surgeries often alter food’s digestion and normal flow, creating conditions conducive to bezoar development.
Changes in the digestive anatomy can impair motility and reduce the stomach’s ability and time to process food effectively. This can result in the retention of food particles, which can clump together and form bezoars as they pass through, needing additional medical interventions.
Slow Digestion
Gastroparesis, characterized by delayed stomach emptying, significantly increases the risk of bezoar formation. It can arise from vagus nerve damage, impairing stomach muscle motility. Weakened muscle contractions hinder food movement, causing food to remain longer and increasing the likelihood of clumping and forming solid masses.
Conditions like hypothyroidism and cystic fibrosis also decrease gastric motility, elevating bezoar risk. Hypothyroidism slows digestion, leading to delayed gastric emptying. At the same time, cystic fibrosis produces thick mucus, blocking food movement through the gastrointestinal tract.
Diabetes
Diabetes, particularly if poorly controlled, can contribute to bezoar development due to its association with gastroparesis, often referred to as diabetic gastroparesis. High blood sugar levels can damage the nerves over time, leading to vagus nerve impairment, causing delayed gastric emptying and impaired digestion.
This nerve damage disrupts the normal contraction of stomach muscles, causing food to remain in the stomach longer than usual. The combination of diabetes and gastroparesis creates an environment conducive to bezoar formation, as undigested food can accumulate and compact into solid masses.
Dietary Habits
Dietary habits play a crucial role in bezoar formation. Consuming high-fiber foods, like fruits and vegetables, without adequate chewing can lead to phytobezoars. Indigestible plant fibers accumulate in the stomach or intestines if not properly broken down before swallowing.
Additionally, certain foods, such as persimmons, can contribute to the formation of diospyrobezoars. The tannins in persimmons react with stomach acid to form a sticky, glue-like substance that can clump together with other food particles, creating a solid mass.
Medications
Certain drugs can alter how your stomach processes and moves food, creating conditions conducive to bezoar formation. Drugs that reduce stomach acid, such as proton pump inhibitors, can lead to incomplete digestion of food and accumulation of undigested particles.
Other medications, like anticholinergics, can slow gastric motility. When stomach motility is reduced, food remains in the stomach for a prolonged period, creating an environment susceptible to food mass formation.
Hair-Eating Behavior
Hair-eating behavior, trichophagia, is a significant risk factor for trichobezoars. This condition is often associated with trichotillomania, a psychiatric disorder characterized by the compulsive pulling and eating of one’s hair. Ingested hair accumulates in the stomach, as the gastrointestinal system cannot digest its primary protein, keratin.
It forms a solid mass called trichobezoars, which can cause blockages and serious complications. These masses grow large before causing noticeable symptoms, challenging early detection and intervention.
Symptoms of Bezoar Development
When a bezoar forms in your digestive tract, it can lead to uncomfortable symptoms affecting daily life, though some people are asymptomatic. These symptoms signal digestive issues. . Understanding them helps with early detection and allows us to distinguish them from other digestive-related problems to seek prompt treatment.
Stomach Pain
A primary symptom of bezoar development is gastrointestinal discomfort, often presenting as persistent stomach pain. This pain, which can be either dull or sharp, is usually concentrated in the upper abdomen and can vary in intensity.
The discomfort worsens after meals as the stomach struggles to process and move food past the blockage, significantly impacting daily activities and overall quality of life. The bezoar’s physical presence exerts pressure within the stomach, contributing to the pain.
Bad Breath
Halitosis, or bad breath, can indicate bezoar development. The buildup of undigested food and other materials in the stomach produces foul-smelling gases that rise through the esophagus, causing persistent bad breath that is resistant to standard oral hygiene measures.
This symptom can be socially and personally distressing, affecting self-esteem and interactions with others. It indicates an underlying issue in the digestive system that needs to be addressed.
Nausea and Vomiting
Nausea and vomiting frequently occur with bezoar development. The bezoar creates a blockage that hinders the smooth passage of food through the stomach, causing pressure buildup. This pressure can trigger the body’s natural instinct to expel the contents through the mouth, leading to nausea and vomiting.
The frequency and intensity of these episodes can vary, often worsening after meals, causing significant discomfort and disrupting daily life. Persistent vomiting can also lead to dehydration and electrolyte imbalances, further complicating the individual’s health.
Abdominal Bloating
Abdominal bloating occurs when a bezoar creates a blockage in the digestive tract, preventing the normal movement of food and gas. This blockage leads to gas buildup, causing the abdomen to feel swollen and uncomfortable.
The bloating can be persistent and may worsen after eating, leading to significant discomfort and a feeling of fullness. This can interfere with daily activities and reduce overall quality of life, as the sensation often mimics overeating.
Changes in Bowel Habits
Bezoars can cause noticeable changes in bowel habits, such as constipation or diarrhea. Obstructing the digestive tract can slow down or block food and waste passage, leading to infrequent, hard, and difficult-to-pass stools and causing additional discomfort and pain.
Conversely, individuals may experience diarrhea if the bezoar causes partial obstruction, allowing only liquid to pass through. This irregularity can be distressing and unpredictable. Altered food and waste movement through the intestines leads to bloating and cramps, showing the interconnection between the symptoms and effects of this condition.
Loss of Appetite and Weight Loss
A bezoar’s presence can drastically affect appetite and cause unintended weight loss. Discomfort and pain decrease the desire to eat, as individuals fear worsening their symptoms. Feeling full after small meals leads to reduced meal sizes and less frequent eating.
Additionally, suppose the bezoar is large enough to slow down digestion. In that case, you may feel full for extended periods, diminishing your desire to eat. Not adequately addressed can lead to unintended weight loss and malnutrition.
Complications Caused by Bezoars
Bezoars can cause numerous long-term health issues if not treated promptly. Understanding these potential complications underscores the importance of seeking medical attention for early diagnosis and treatment.
Digestive Obstruction
Gastrointestinal obstruction is a severe complication caused by bezoars. When a bezoar blocks the digestive tract, it prevents food and liquids from passing through the stomach and intestines, causing severe abdominal pain, bloating, vomiting, and an inability to pass gas or stool.
If not treated promptly, bezoars can cause bowel perforation, leaking food and fluids outside the digestive tract, or ischemia, where the blood supply to the intestines is cut off, resulting in tissue death. Severity varies, but extreme cases can lead to complete blockage or infection, requiring emergency medical intervention.
Stomach Ulcers
Bezoar can create constant pressure and friction against the stomach lining, eroding its protective mucosal layer. If untreated, this persistent pressure can lead to gastric ulcers and open sores along the stomach lining.
If they bleed or perforate, gastric ulcers can cause significant discomfort and complications. Continuous irritation from a bezoar can exacerbate ulcer formation, leading to more severe health issues.
Intestinal Damage or Tear
Intestinal damage or perforation can occur when a bezoar exerts excessive pressure, weakening the intestinal lining and causing tears or holes. Perforation allows intestinal contents to leak into the abdominal cavity, causing severe infection and inflammation known as peritonitis.
Peritonitis is a medical emergency that demands immediate treatment to prevent sepsis and other life-threatening complications. The presence of a bezoar dramatically increases the risk of intestinal damage.
Bleeding and Anemia
Bezoars can cause gastrointestinal bleeding, a severe complication requiring immediate medical attention. Constant irritation damages the gastrointestinal tract lining, leading to bleeding. Symptoms such as blood in the stool or vomit indicate the need for urgent evaluation and treatment.
Chronic bleeding from a bezoar can be life-threatening, as it can lead to anemia. Anemia is characterized by fatigue, pallor, and shortness of breath, significantly impacting an individual’s overall health and quality of life.
Detecting Bezoars
Accurate diagnosis is crucial for determining the best-personalized treatment plan. Confirming its presence involves various procedures that help to understand the size, location, and type of bezoar present.
Physical Examination and Medical History
The diagnostic process typically starts with a comprehensive physical exam and an in-depth review of the patient’s medical history. During the physical exam, a healthcare provider may palpate the abdomen to identify any abnormal masses or tenderness suggesting a bezoar.
The patient’s medical history, including dietary habits, past surgeries, and gastrointestinal issues. Recognizing symptoms helps pinpoint causes and directs further tests. Special precautions are needed when examining children, as they may hide bezoar-related behaviors a secret, requiring a sensitive approach to discover the root cause of the unintended obstruction.
Blood Tests
Laboratory tests support the diagnosis of bezoar by identifying associated complications. A Complete Blood Count can detect anemia, which may result from chronic gastrointestinal bleeding caused by a bezoar. Though not required for diagnosis, blood tests help narrow down health conditions for the healthcare provider to consider.
Other blood tests, such as electrolyte panels and liver function tests, can help assess the presence of related health conditions or markers of complications. These tests identify imbalances or abnormalities related to a bezoar, providing crucial information for developing a comprehensive treatment plan.
Imaging Tests
Imaging studies are vital for diagnosing bezoars by visually confirming the mass in the gastrointestinal tract. Abdominal X-rays can occasionally detect bezoars with substantial gas or calcified material. However, X-rays may not identify bezoars made of non-radiopaque substances like hair or plant fibers.
Ultrasound is a non-invasive imaging method that uses sound waves to create images of abdominal organs in a localized area based on presentation, aiding in identifying bezoars. CT scans provide more detailed images, effectively diagnosing bezoars by showing their size, shape, location, and related complications such as obstruction or perforation.
Endoscopy
Endoscopy is the most effective diagnostic tool for detecting bezoars. During the procedure, an endoscope—a flexible tube with a camera, is inserted through the mouth into the stomach. This allows direct visualization of the gastrointestinal tract from the inside, confirming bezoars’ presence, even those not clearly visible in imaging studies.
Endoscopy offers detailed images that reveal the precise location and nature of the bezoar, enabling accurate diagnosis and informing subsequent treatment decisions. Additionally, endoscopy can be used to obtain tissue samples or biopsies.
Bezoars in Children
Bezoars can occur in children who are more likely to ingest non-food items like hair and paper. Certain medical conditions, such as pica, characterized by eating non-food items, predispose them to bezoars. These behaviors increase the risk of bezoar formation in the digestive tract.
Detecting bezoars in children is challenging as they may struggle to express symptoms or hide their actions to avoid scolding or reprimanding. Parents must note changes in behavior, eating habits, and physical symptoms as children may endure them and keep them to themselves.
Pediatricians may rely more on imaging studies and exploratory procedures to diagnose bezoars accurately. Along with medical evaluations, behavioral and dietary assessments are essential. Understanding the child’s dietary habits and intake helps diagnose and prevent bezoar recurrence.
Treatment for Bezoars
The treatment approach is determined by the bezoar’s nature, where it’s found within the digestive system, and how severe the presenting symptoms are. Each method aims to remove the bezoar and restore normal digestive function effectively.
Chemical Breakdown
Dissolution therapy uses specific chemical agents to break down bezoars, facilitating natural bodily passage. This approach is typical for phytobezoars, employing enzymes or compounds ingested to dissolve plant material effectively. It’s non-invasive and suitable if there’s no severe obstruction.
Dissolution therapies must be tailored to the bezoar type. This method can take time and might not be suitable for all bezoar types, particularly those composed of hair or medications. Other treatment methods may be necessary to ensure effective resolution in such cases.
Laser Therapy
Laser therapy is a cutting-edge treatment that breaks bezoars into smaller, more manageable fragments. During the procedure, a laser is directed at the bezoar through an endoscope, allowing it to be broken down without needing an open surgery.
This technique is particularly beneficial for hard or compact bezoars that do not respond to enzyme treatments or other non-invasive methods. However, due to the specialized equipment and expertise required, it is only available in advanced medical centers and health facilities.
Digestive Tract Scope Removal
Endoscopic removal uses an endoscope, a flexible tube equipped with a camera and tools, to visualize and extract the bezoar from the digestive tract directly. This minimally invasive procedure enables immediate removal without the need for major surgery.
Endoscopic removal is especially effective for bezoars in the stomach or upper intestines. Compared to surgical options, it offers reduced recovery time and a lower risk of complications. This approach is favored for its efficiency and minimal invasiveness.
Surgical removal is required when a bezoar is too large, hard, or impacted for dissolution therapy or endoscopic treatment. This procedure involves making abdominal incisions to access the digestive tract and manually removing the bezoar. It is more invasive, with higher risks and longer recovery times.
Surgery is necessary if the bezoar causes significant obstruction or perforation or is in a part of the digestive system not easily reached by endoscopy. This approach is also needed when repairing or altering the affected area where the bezoar is lodged, allowing for complete recovery and preventing future occurrences.
Prevention Strategies
Understanding how to prevent bezoars is essential for maintaining your digestive health and avoiding the complications they can cause. Adopting a particular lifestyle and dietary habits can significantly reduce your risk of developing it.
Healthy Eating Habits
Healthy eating habits are essential for preventing bezoar formation. A balanced diet with well-chewed, easily digestible foods minimizes the risk of undigested material accumulating in the stomach. Limiting the intake of high-fiber foods, like certain fruits and vegetables, can also be beneficial.
Eating slowly and avoiding swallowing large chunks of food are essential practices. A varied diet ensures that the digestive system efficiently processes nutrients, reducing the chance of bezoar development. Regular meals and mindful eating practices further promote digestive health.
Increasing Fluid Intake
Staying well-hydrated is crucial in preventing bezoars. Adequate fluid intake ensures the digestive system functions smoothly by helping food pass through the gastrointestinal tract. Water aids in breaking down and absorbing nutrients, preventing undigested material from accumulating.
Proper hydration also softens food particles, making them easier to digest and pass through constrictions in the digestive system. Drinking plenty of water throughout the day supports overall digestive health. It reduces the risk of bezoar formation, especially when consuming high-fiber foods.
Behavior Therapy
Behavioral therapy can effectively prevent bezoars, particularly for individuals with pica or trichotillomania. This therapy addresses the underlying psychological issues that lead to ingesting non-food items, thereby reducing the risk of bezoar formation.
Cognitive-behavioral therapy (CBT) techniques can help individuals develop healthier coping mechanisms and avoid behaviors contributing to bezoar development. By addressing the root causes of these behaviors, behavioral therapy can significantly decrease the likelihood of bezoar recurrence and enhance overall mental health.
Frequently Asked Questions
What is a bezoar, and what are its types?
A bezoar is a mass formed by accumulating substances the body cannot digest, leading to blockages and discomfort in the digestive system. The composition can range from undigested food particles to fiber, hair, or other non-food substances.
Based on their composition, bezoars are classified into specific types: phytobezoars (plant fibers), trichobezoars (hair), pharmacobezoars (undissolved medication), lactobezoars (milk protein), foreign body bezoars (non-food items), and diospyrobezoars (persimmons).
What are the common symptoms of bezoars?
The formation of bezoars can lead to several uncomfortable symptoms, including stomach pain, bad breath, nausea and vomiting, abdominal bloating, changes in bowel movement, loss of appetite, and weight loss.
The intensity and occurrence of these symptoms can differ based on the bezoar’s size and its position within the digestive tract. If left unaddressed, these symptoms can lead to complications like gastrointestinal obstruction, gastric ulcers, intestinal damage such as perforation and peritonitis, bleeding, and anemia.
How are bezoars diagnosed?
The diagnosis of bezoars involves a physical examination and reviewing the patient’s medical history. Symptoms, dietary habits, and risk factors for bezoar formation are discussed. Special precautions are needed when examining children, as they may hide bezoar-related behaviors, requiring a sensitive approach for accurate diagnosis and treatment.
Blood tests support the diagnosis by identifying associated complications. Imaging tests like X-rays, ultrasound, or CT scans are then conducted to visualize the bezoar and ascertain its size, shape, and location. In some cases, an endoscopy is performed for direct visualization and even extraction of the bezoar.
What are some effective treatments for bezoars, and how can they be prevented?
Bezoars can be treated using dissolution for phytobezoars, laser therapy to break them into smaller fragments, endoscopic removal for minimally invasive immediate removal, or surgical removal for large, hard, or impacted bezoars. The healthcare team decides the treatment methods depending on the type, location, and severity of symptoms.
Prevention strategies include adopting healthy eating habits, such as a balanced fiber-rich diet, thoroughly chewing food, and staying hydrated. Behavioral therapy can be very effective for individuals with predisposing behaviors like trichophagia or pica.
