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Bezoar
Last reviewed: 12.07.2025
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A bezoar is a solid mass of partially digested and undigested material that cannot be evacuated from the stomach. It is often seen in patients with impaired gastric emptying, which may be caused by gastric surgery. Many bezoars are asymptomatic, but some develop signs of gastric outlet obstruction. Some bezoars can be dissolved enzymatically, while others require endoscopic or surgical removal.
Partially digested accumulations of plant food or hair are called phytobezoars or trichobezoars, respectively. Pharmacobezoars are dense accumulations of medications (especially sucralfate and aluminum hydroxide gel). Various other substances may also be found in bezoars.
[ What causes a bezoar?
Trichobezoars, which can weigh several kilograms, usually develop in patients with mental disorders who chew and swallow their own hair. Phytobezoars are often found in patients after Billroth I or II gastrectomy, especially when the operations were accompanied by vagotomy. Hypochlorhydria, decreased antral motility, and incomplete chewing of food are the main predisposing factors. Other factors include gastroparesis in diabetes and gastroplastic surgery in obesity. Finally, consumption of persimmon (a fruit containing tannin that polymerizes in the stomach) causes the formation of bezoars, which require surgical treatment in more than 90% of cases. Persimmon bezoars are most common in regions where the fruit is grown.
Symptoms of a bezoar
Most bezoars are asymptomatic, although post-meal fullness, nausea and vomiting, abdominal pain, and gastrointestinal bleeding may occur.
Diagnosis of bezoar
Bezoars are diagnosed as masses on imaging tests (e.g., X-ray, ultrasound, abdominal CT ) performed to evaluate upper GI symptoms. They may be mistaken for tumors; upper GI endoscopy is usually performed. On endoscopy, bezoars have a characteristic irregular surface that varies in color from yellow-green to gray-black. Endoscopic biopsy is diagnostic and may reveal hair or plant material.
Treatment of bezoar
If a bezoar is diagnosed during endoscopy, an attempt to remove it can be made immediately. Fragmentation of the formation with forceps, a wire loop, a stream of liquid, or even a laser can destroy the bezoar, creating conditions for its natural evacuation or removal. Metoclopramide 40 mg intravenously per day or 10 mg intramuscularly every 4 hours for several days helps to increase peristalsis and promotes gastric emptying of fragmented material.
If endoscopic removal was not performed initially, bezoar treatment is symptomatic. In asymptomatic bezoars discovered incidentally during examination for other indications, no special intervention is required. In some cases, enzymatic therapy may be undertaken.
Enzymes include papain (10,000 U with each meal), meat tenderizers [5 ml (1 teaspoon) in 8 oz of clear liquid before meals], or cellulose (10 g dissolved in 1 L of water for 24 hours, 2 to 3 days). If enzyme therapy is ineffective or if symptoms occur, endoscopic removal of the bezoar is indicated. Stony dense lesions and trichobezoars usually require laparotomy.