Gastric bezoars can give rise to various debilitating symptoms. Affected individuals suffer from delayed gastric emptying, nauseas, vomiting, and early feeling of satiety, anorexia, weight loss, dysphagia and abdominal bloating. About 80% of patients with bezoar suffer from epigastric discomfort [6].

Bezoars which develop in the esophageal route, present with signs and symptoms of odynophagia, retrosternal pain and dysphagia.

• Weight Loss

  A previously healthy 18-year-old woman presented with a 5-month history of pain in the left upper quadrant of the abdomen, abdominal distention, postprandial emesis, and weight loss of 18 kg. [content.nejm.org]

  They usually present with abdominal pain, intestinal obstruction, weight loss, poor appetite, or vomiting. The CT scan of the abdomen is the preferred method of diagnosis. [ncbi.nlm.nih.gov]

  A 50-year-old woman was admitted in 1980 with a threeweek history of vomiting, epigastric pain and weight loss. In 1971 she had undergone surgery for hiatus hernia. [birpublications.org]

  Symptoms: Symptoms of bezoars include delayed gastric emptying, early satiety value, loss of appetite, nausea accompanied by vomiting, weight loss, dysphagia, retrosternal pain and odynophagia. [symptoma.com]

  Presenting symptoms were early satiety, intermittent vomiting and weight loss. [endoatlas.com]

• Anorexia

  OBJECTIVE: To report the case of a gastric bezoar in a patient with anorexia nervosa (AN). METHOD: Case report of a bezoar of the stomach occurring in AN and a review of the literature relating to bezoars and AN from PubMed. [ncbi.nlm.nih.gov]

  Key words Anorexia nervosa eating disorders bezoar gastric gastrointestinal This is a preview of subscription content, log in to check access. References 1. Scobie B.A.: Acute gastric dilatation and duodenal ileus in anorexia nervosa. Med. J. [link.springer.com]

  Predisposition Previous gastric surgery such as vagotomy, pyloroplasty, antrectomy or partial gastrectomy Inadequate chewing of food Missing teeth, dentures Massive overindulgence of food with high fiber contents such as dates or persimmons Clinical symptoms Anorexia [learningradiology.com]

  When symptoms are present, the most common include postprandial fullness, abdominal pain, nausea, vomiting, anorexia, and weight loss. [msdmanuals.com]

• Soft Tissue Mass

  Chapters A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Professional / StandaloneMedia / Bezoar (Imaging Study Findings) Bezoar (Imaging Study Findings) In the x-ray image on the left, the bezoar is indicated by the midline upper abdominal large soft-tissue [msdmanuals.com]

  No evidence of a soft tissue mass, regional lymphadenopathy or ischemia was present. [ijri.org]

  Kim et al. found that in 11% of the cases, phytobezoar can appear as a soft tissue mass without gas making diagnosis difficult as it can resemble an intraluminal tumour or intussusception. [biij.org]

  Female patient, aged 15 – standing X-ray of the abdomen: a soft tissue opacity mass in the mesogastrium and the right epigastrium overlapped by the colon. [ncbi.nlm.nih.gov]

• Swelling

  However, as such preparations are widely commercially available, it is important for gastroenterologists to be aware of their potential to form a bezoar in the esophagus due to swelling on contact with liquid. [ncbi.nlm.nih.gov]

  Computed tomography images showed diffuse brain swelling and unclear corticomedullary junctions, and electroencephalography revealed no brain activity. [onlinelibrary.wiley.com]

  Associated symptoms included epigastric swelling pain, nausea and vomiting. The pain was relieved after vomiting. The patient treated it as stomach disorders, which proved to be ineffective. The symptoms got worse nine days prior to admission. [biomedres.info]

  So, it's just bile... and that is making my throat swell like I have strep. I'm on a new anxiety medication, so I hope that helps. I'm really anxious and nervous about my website. I want people to use it as a resource. [emilysstomach.com]

• Fishing

  Sanderson I, Ibberson O, Fish EB. Gastric phytobezoar following gastrectomy. Can Med Assoc J 1971. 104:1115. PMID : 5580753. 10. Krausz MM, Moriel EZ, Ayalon A, Pode D, Durst AL. Surgical aspects of gastrointestinal persimmon phytobezoar treatment. [doi.org]

• Vomiting

  Possible Complications Persistent vomiting can lead to dehydration. When to Contact a Medical Professional Call your provider if you suspect your child has a bezoar. [huronregional.org]

  They usually present with abdominal pain, intestinal obstruction, weight loss, poor appetite, or vomiting. The CT scan of the abdomen is the preferred method of diagnosis. [ncbi.nlm.nih.gov]

  One year after the surgery, she has no abdominal pain or vomiting. She has regained approximately 9 kg of body weight and reports that she has stopped eating her hair. [content.nejm.org]

• Nausea

  A 75-year-old Japanese woman presented with nausea and appetite loss. Computed tomography showed a radiopaque substance in the stomach. Esophagogastroduodenoscopy revealed bezoars in the stomach, which were endoscopically retrieved. [ncbi.nlm.nih.gov]

• Epigastric Pain

  A 50-year-old woman was admitted in 1980 with a threeweek history of vomiting, epigastric pain and weight loss. In 1971 she had undergone surgery for hiatus hernia. [birpublications.org]

  She presented with epigastric pain, nausea, and vomiting. Upper gastrointestinal endoscopy, performed at a local hospital, showed 2 gastric bezoars in the stomach, and 1 of them impacted at the pylorus. [ncbi.nlm.nih.gov]

  Case Report A 52-year-old woman admitted to the hospital with more-thanone- month history of intermittent epigastric pain. Associated symptoms included epigastric swelling pain, nausea and vomiting. The pain was relieved after vomiting. [biomedres.info]

  Fifteen days later, the bezoar dissolved ( Figure 2 ) and the epigastric pain resolved. The patient was then lost to follow up. However, 1 month later, he visited the emergency room for abdominal pain with vomiting. [doi.org]

• Delayed Gastric Emptying

  Gastric bezoars can give rise to various debilitating symptoms. Affected individuals suffer from delayed gastric emptying, nauseas, vomiting, and early feeling of satiety, anorexia, weight loss, dysphagia and abdominal bloating. [symptoma.com]

  Left: 69 year-old man with diabetes mellitus and end-stage renal disease with gastroparesis (delayed gastric emptying), who presented with nausea, postprandial vomiting and early satiety. [endoatlas.com]

  Doctors should be aware of the risks of bezoar formation and potential intestinal obstruction with sucralfate in seriously ill patients, especially those receiving concomitant enteral feeds or who have predisposing conditions such as delayed gastric emptying [apps.who.int]

  PubMed Google Scholar Brady PG: Gastric phytobezoars consequent to delayed gastric emptying. Gastrointest Endosc. 1978, 24: 159-161. [jmedicalcasereports.biomedcentral.com]

  Brady PG: Gastric phytobezoars consequent to delayed gastric emptying. Gastrointest Endosc 1978;24:159-161. Crossref 2. Debakey M, Oshsner H: Bezoars and concretions. Surgery 1939;5:132-160. 3. Cohen NN, Strika ZA: The medical treatment of bezoars. [jamanetwork.com]

• Early Satiety

  Presenting symptoms were early satiety, intermittent vomiting and weight loss. [endoatlas.com]

  satiety History of trichophagy – eating hair Trichoptysis – hair may be coughed up May be asymptomatic Phytobezoar (55% of all bezoars): Poorly digested vegetable fibers such as Skin and seeds of fruits and vegetables Oranges Persimmons Most common Unripe [learningradiology.com]

  But when symptoms do develop, they typically include abdominal pain, nausea, vomiting, early satiety, foul breath, and weight loss. Sometimes, the abdomen feels tender. I checked with Gerard E. [drweil.com]

  Symptoms: Symptoms of bezoars include delayed gastric emptying, early satiety value, loss of appetite, nausea accompanied by vomiting, weight loss, dysphagia, retrosternal pain and odynophagia. [symptoma.com]

  Early satiety and better tolerance to liquid than solid food may represent gastric dilatation, which may be appreciated by succussion splash. [jmedicalcasereports.biomedcentral.com]

• Heart Failure

  Failure in Seniors ACG Issues Guideline for Management of Upper GI Bleeding American College of Cardiology, May 15-17 View All News > View All News > PROCEDURES The Vaginal Exam in Labor Uterine Compression Uterine Balloon Tamponade View All Procedures [msdmanuals.com]

• Skin Disease

  OTHER Also effective for skin diseases, acne, tumor, hardening of coronary vessels. For relieving wind, heartburn, gastric and other diseases. [porcupinebezoar.com]

• Behavior Disorder

  Gastric bezoars can occur in all age groups and often occur in patients with behavior disorders, abnormal gastric emptying, or altered GI anatomy. Many bezoars are asymptomatic, but some cause symptoms. [msdmanuals.com]

Physical examination is of little importance in diagnosing bezoars. However, apparently a palpable mass may be detected during physical exam. However, such finding may be an indication of other conditions and therefore more discrete examination needs to be conducted.

Plain radiographs would help in detection of mass in the abdomen. For more distinct analysis, barium swallow X-ray is indicated. In many instances, endoscopy would also be required for determining bezoars in the esophagus or stomach [7]. In addition, CT scan of the abdomen is also indicated for diagnosing bezoars and identifying associated complications [8].

• Small Bowel Mass

  […] sign, and a lesion in the stomach that appears similar to the obstructive mass is typical of small-bowel bezoar; an isolated amorphous mass mottled with gas bubbles is typical of small-bowel feces. [ajronline.org]

• The primary goal of treatment of bezoars is their removal and designing preventive strategies to prevent recurrence. Surgical removal of bezoars forms the preliminary basis of treatment regime. Other treatment methods consist of endoscopic fragmentation, dissolution of the bezoars with enzymes such as cellulase or proteolytic enzymes, gastric lavage and dietary modifications with inclusion of more fibrous foods. The mode of treatment employed would largely depend on type and location of the bezoar.
• Majority of the bezoars would require operative removal due to the underlying risks that they carry. Endoscopic methods to remove the bezoars have also achieved considerable amount of success. This mode of treatment is majorly used of trichobezoars. Phytobezoars can be enzymatically removed by dissolving them with various enzymes. Papain, which is a proteolytic enzyme, is also used for removal of phytobezoars.
• An alternative enzyme therapy involving the use of cellulase for dissolving the phytobezoars has been found to be successful. The cellulase enzyme binds the leucoanthocyanidin-hemicellulose-cellulose bonds, which then dissolves the bezoar [9].
• The method of gastric lavage which is done using 3 liters of coca cola beverage over a 12 hour period helps in dissolution of phytobezoars [10]. 

The prognosis of the condition is extremely favorable with full recovery. Medications or surgery can help get rid of the bezoar and individuals can also get prompt relief from the debilitating symptoms [5].

Consumption of substances containing hair or fizzy materials knowingly or unknowingly favors the development of bezoars. The incidence of bezoars is a common occurrence in animals. In humans, it is thought to occur in children or adults with intellectual disability or in those who are suffering from psychiatric illness [2]. Apart from being a common occurrence in this population, bezoars in adult patients occur due to manipulation during operative procedures such as vagotomy and partial gastrectomy [3].

In addition, there are various other predisposing factors that favor bezoar formation. These include disease conditions such as diabetes mellitus, hypothyroidism, Miltonic dystrophy, Guillain-Barré syndrome, cystic fibrosis and intrahepatic cholestasis.

The incidence rate of bezoars in humans is low. Mortality rates associated with the condition is about 30%. The fruit persimmon has been linked to occurrence of bezoars in humans. It has been reported that, excessive consumption of persimmon caused an outbreak of intestinal bezoars. About 90% cases of intestinal bezoars occurred due to high consumption of persimmon.

Animals are known to fall easy prey to this condition. In the past era, in the Middle Ages bezoars were considered as valuable possessions and were frequently used for designing jewelry. 

Bezoars are composed of undigested materials and may contain hair, fiber, medications, food or even chewing gum. These materials do not get digested and as a result also do not pass down the small intestine. Bezoars are more commonly found in the stomach, although they can develop anywhere between the esophagus and rectum.
Individuals with past history of gastric surgery or an altered function of gastric motility, wherein there is significant loss of peristaltic motility, are more prone to develop bezoars [4].

Individuals who have suffered from a bezoar in the past should be careful about its recurrence in future. Parents should be cautious and keep an eye on children who have habit of putting everything inside their mouth. All indigestible materials should be kept out of reach and they should also cut their children’s hair short, so that they can no longer chew their hair.

Indigestible materials may get trapped in the gastrointestinal system. As these are not digested, they do not further pass through the small intestine. Bezoars are of 4 types which have been categorized based on their composition: phytobezoars, trichobezoars, lactobezoars and pharmacobezoars. Phytobezoars constitute of vegetable matter and are the most common form; whereas trichobezoars consists of hair and fiber materials. Lactobezoars primarily consist of undigested milk matter and pharmacobezoars are also known as medication bezoars which form due to certain medications [1].

• Definition: A bezoar is a mass of indigested material that gets accumulated in the gastrointestinal system and give rise to debilitating complications. These comprise of food materials, chewing gum, hair and medications. If these enter the system, they do not get digested and eventually accumulate and form a mass.
• Cause: Consumption of indigestible materials either knowingly or unknowingly gives rise to formation of bezoars. Individuals suffering from psychiatric illness or those who have undergone surgery are more likely to develop bezoars.
• Symptoms: Symptoms of bezoars include delayed gastric emptying, early satiety value, loss of appetite, nausea accompanied by vomiting, weight loss, dysphagia, retrosternal pain and odynophagia. Untreated bezoars can pave way for life threatening complications such as ulceration, necrosis and gastrointestinal bleeding.
• Diagnosis: Physical examination is of little value in diagnosing bezoars. However, a palpable mass during the examination can provide a clue for some underlying problem. In addition, radiographs and barium swallow X-ray can be of considerable help in diagnosing bezoars. CT scan of the abdomen is also indicated.
• Treatment: Surgery or dissolution by enzymes forms the preliminary basis of treatment regime. Surgical removal of the bezoars is one of the most common methods of treating the condition. Dissolution by enzymes such as cellulase or proteolytic enzymes also helps in treatment of bezoars. Use of coca cola beverage in gastric lavage has also achieved considerable amount of success in treating phytobezoars.

1. Lee J. Bezoars and foreign bodies of the stomach. Gastrointest Endosc Clin N Am 1996; 6:605.
2. Kamal I, Thompson J, Paquette DM. The hazards of vinyl glove ingestion in the mentally retarded patient with pica: new implications for surgical management. Can J Surg 1999; 42:201.
3. Brady PG: Gastric phytobezoars consequent to delayed gastric emptying. Gastrointest Endosc 1978, 24:159-161.
4. Kadian RS, Rose JF, Mann NS. Gastric bezoars--spontaneous resolution. Am J Gastroenterol 1978; 70:79.
5. Calabuig R, Navarro S, Carrio I, Artigas V, Mones J, Puig LaCalle J: Gastric emptying and bezoars. Am J Surg1989, 157:287-290.
6. Robles R, Parrilla P, Escamilla C, Lujan JA, Torralba JA, Liron R, Moreno A: Gastrointestinal bezoars. Br J Surg1994, 81:1000-1001.
7. Wang YG, Seitz U, Li ZL, et al. Endoscopic management of huge bezoars. Endoscopy 1998; 30:371.
8. Newman B, Girdany BR. Gastric trichobezoars--sonographic and computed tomographic appearance. Pediatr Radiol 1990; 20:526.
9. Rider JA, Foresti-Lorente RF, Garrido J, et al. Gastric bezoars: treatment and prevention. Am J Gastroenterol 1984; 79:357.
10. Ladas SD, Kamberoglou D, Karamanolis G, et al. Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Aliment Pharmacol Ther 2013; 37:169.