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]

  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]

  Where symptoms do appear, these may include: feeling full after eating very little food a lack of appetite nausea vomiting abdominal pain weight loss anemia Although older adults are generally at greater risk for phytobezoars, certain types of bezoars [healthline.com]

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

• Anorexia

  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]

  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]

  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]

• Movement Disorder

  Pantelis Stathis, Vasilios Tzias, Pavlos Argyris, Georgia Barla and Maria Maltezou, Gastric bezoar complication of Duodopa®therapy in Parkinson's disease, treated with Coca-Cola®, Movement Disorders, 29, 8, (1087), (2014). [doi.org]

• Sputum

  Urine culture and sputum AFB were negative. Her amylase level was normal. Prior to admission to our hospital, the patient had a barium meal and follow-through examination and CT scan of the abdomen done at the referring hospital. [biij.org]

• Vomiting

  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]

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

  Vomiting continued and the dysphagia worsened. The patient then underwent an upper gastrointestinal endoscopy (using Olympus GIF-V2, Olympus Optical Co. [doi.org]

• Nausea

  Patients may present with abdominal pain, nausea, vomiting, anorexia, weight loss, intestinal bleeding from pressure ulcer necrosis, or intestinal obstruction. [karger.com]

  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]

• Early Satiety

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

  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]

  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]

• Loss of Appetite

  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]

  There was no history of weight loss, but she did report early satiety and loss of appetite. This woman had a history of peptic ulcer disease over 20 years ago in Kenya. It had led to GOO requiring truncal vagotomy and gastrojejunostomy. [jmedicalcasereports.biomedcentral.com]

  […] feels tender Foul breath, and Loss of weight. [gastrodigestivesystem.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]

• Murphy's Sign

  The patient showed abdominal tenderness, positive Murphy sign, hyperactive bowel sounds, a pale tongue with scalloped edges, greasy moss, and pulse moisten. A complementary examination revealed the presence of occult blood in the vomit. [ncbi.nlm.nih.gov]

• Dysuria

  A 67-year-old man developed dysuria and position-dependent obstructive voiding symptoms after undergoing holmium laser ablation of the prostate (HOLAP) for benign prostatic hypertrophy. [ncbi.nlm.nih.gov]

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]

• Polyps

  No other intraluminal mass or polyps was found, excluding other causes of obstruction. Bowel distal to the mass was collapsed. The characteristic CT findings immediately alerted us to the diagnosis of a bezoar. [biij.org]

  Other benign intraluminal causes in adults include gastric polyps, caustic ingestion, gallstone obstruction (Bouveret syndrome), and bezoars. [jmedicalcasereports.biomedcentral.com]

• 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.

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