Bezoars are lumps of food and/or non-food particles that remain undigested or are partially digested by the stomach. While not usually a serious medical concern, the fact that they present little to no symptoms may result in continued growth of the lump, which may then block the gastrointestinal pathways.
However, most bezoars are easy to remove, with some even being fully preventable.
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Diagnosis:
Since obvious physical symptoms are uncommon, bezoars are generally only detected during testing for separate gastrointestinal issues or bodily conditions, or a yearly physical exam. Some common diagnostic tests for bezoars are:
- CT Scan (an advanced version of x-rays that shows detailed images of internal organs)
- Abdominal Ultrasound
- Endoscopy (non-surgically inserting a small camera into the body to provide a clear view of internal organs on a screen). Endoscopies are usually performed for a detailed analysis when a tumor is suspected.
Bezoars generally range in color between brown, green, yellow, and black depending upon the formative materials (fiber, food particles, hair, lactose, etc.) and their rate of decay. Moreover, while usually only a single bezoar occurs at a time, multiple smaller masses may also form in some cases.
Complications:
Along with blocking the gastric canal, unremoved or untreated bezoars can result in the following complications:
- Disrupting the lining of the stomach, small intestine, or large intestine, resulting in a stomach ulcer or other gastrointestinal ulcers.
- This disruption can also cause gastrointestinal bleeding, which can often be identified by blood in stool.
- Gangrene or tissue death in a portion of the stomach or intestines.
- Severe stomach cramps and bloating
- Intussusception, i.e. sliding of one segment of the intestine into another, resulting in intestinal blockage and even gangrene, in extreme cases.
- Perforation (hole) in the digestive tract, which then allows food, digestive juices, and/or intestinal contents like stool to leak into the stomach and other nearby organs. This can lead to severe inflammation if left untreated.
Treatment:
The treatment options for bezoars are limited, but highly effective and include:
1-Dissolution:
This particular treatment involves either dissolving the bezoar or softening and breaking it into smaller pieces to allow it to pass through the body naturally with stool.
For this purpose, special medication, usually metoclopramide (10 mg) pills, are prescribed. Alternatively, 3-5 g of cellulase can also be prescribed to be dissolved and taken orally for 3-5 days.
Cola in controlled amounts may also be prescribed in some cases. Dissolution is generally used for patients with mild symptoms.
2-Endoscopic Removal:
Bezoars that do not respond to or cannot be removed through dissolution via cola, cellulase, or metoclopramide may be removed through an endoscopy. In this process, the bezoar is broken down and extracted from the body for further analysis. Forceps, wire snares, jet sprays, or lasers guided by the endoscope can be used to break the lump.
In some cases, endoscopy may only be used to break down the bezoar, which will then be passed alongside stool. Endoscopic removal is generally employed for patients with moderate to severe symptoms or complications.
3-Surgery:
Very hard bezoars, particularly those made of persimmon seeds (diospyrobezoars), cannot be dissolved or fragmented, and hence require surgical removal.
Prevention:
After successful removal, most bezoars can be prevented from recurring through the following measures:
- Phytobezoars (formed of indigestible fibers) can be prevented by avoiding certain fibrous foods like persimmons, celery, pumpkin, sunflower seed shells, and prunes.
- Chewing food thoroughly and wearing properly-fitted dentures (if any) can also help prevent bezoar formation in older individuals.
- Since trichophagia (compulsive hair sucking, pulling, and swallowing) is the primary cause of trichobezoars, or ‘hairballs’, appropriate psychiatric treatment can help resolve the issue and prevent a recurrence.
Bezoars are easy to treat and prevent. Consult with your doctor if you suspect a bezoar, or book an appointment with a top Gastroenterologist in Lahore, Karachi and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your gastric concerns.
