Bezoars: A Digestive Predicament?

Believed until as close as the late 1900s to possess healing properties as antidotes to various poisons, advancements in medicinal biology have since proven otherwise.

According to gastroenterologists, bezoars are, in fact, a buildup of partially digested or undigested material-both food and non-food particles-in the gastrointestinal tract that gradually form larger, tightly packed masses that can cause a blockage in the digestive tract if allowed to grow.

Types:

Bezoars commonly form in the stomach and sometimes in the small intestine, although large intestinal bezoars are rare as most items are often too small or inconsequential by the time that they reach the large intestine. Depending on the accumulated material, bezoars are divided into the following types:

1-Phytobezoars:

These are the most common type that are composed of indigestible food fibers, usually cellulose. These fibers generally come from fruits and vegetables like raisins, prunes, sunflower-seed shells, leeks, celery, beets, and pumpkins.

• Diospyrobezoars:

  are particularly common phytobezoar subtypes that form from a collection of persimmon seeds. However, they only occur in areas where the fruit is either grown or widely available.

2-Trichobezoars:

Composed primarily of hair coated with decayed, undigested food particles, trichobezoars are also known as ‘hairballs’ and can weigh up to several kilograms. In toddlers, trichobezoars form due to ingesting carpet or clothing fibers.

However, the presence of trichobezoars in older individuals, mostly adolescent girls, might indicate Trichophagia; a psychological condition characterized by compulsive hair-pulling and swallowing. In severe cases, the compact hair fibers can even fill up the stomach and form a ‘tail’ into the small intestine.

3-Lactobezoars:

Made up of undigested milk protein mixed with mucus, lactobezoars are most common in infants and some toddlers.

4-Pharmacobezoars:

A common occurrence in older adults, pharmacobezoars are composed of undissolved medication.

5-Foreign Body Bezoars:

All bezoars composed of indigestible non-food items like paper, polystyrene foam plates and cups, and even parasitic worms are classified under this category. Foreign body bezoars are generally rare and mostly form in toddlers and younger children.

Symptoms:

In most people, bezoars do not completely block the digestive tract, therefore hardly presenting any symptoms. When they do occur, symptoms include:

• Feeling full after eating very little
• Abdominal pain or tenderness
• Unexplained weight loss
• Lack of appetite
• Foul breath
• Vomiting
• Anemia
• Nausea

Risk Factors:

Bezoars can form in people of all ages. And while foreign body and trichobezoars are born of habit or psychological issues, the following conditions increase the risk of phytobezoar development:

• A previous gastric surgery that delays stomach emptying, like gastric band for obesity reduction, peptic ulcer removal, or a gastric bypass.
• Decreased stomach size
• Diabetes, end-stage kidney disease, and certain autoimmune disorders that prevent the stomach from emptying properly.
• Excessive fiber consumption.
• Being on constant mechanical ventilation.
• Certain medications that slow stomach contractions

In older individuals, risk factors include::

• No teeth or poorly fitting dentures that result in improper chewing or the inability to chew food at all.
• Reduced stomach acid production (hypochloridria)

Aside from the presence of the above risk factors, bezoars are unlikely to develop in most individuals.

Bezoars in Children:

While older adults are at a higher risk of phytobezoar development, lactobezoars are generally only restricted to infants and some toddlers, with the following factors increasing the instance of bezoar development:

• Dehydration
• Premature birth and/or low birth weight resulting in an underdeveloped gastrointestinal tract
• High-calorie baby formula consumption
• Extra addition of thickening agents like pectin to baby formula.

Aside from trichobezoars, other bezoars are easily removable and rarely ever cause long-term health effects. Consult with your doctor if you suspect signs of a bezoar, or book an appointment with a top Gastroenterologist in Karachi, Lahoreand Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your gastrointestinal concerns.