Bezoar
Last reviewed: 23.04.2024
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Bezoar is a dense formation, consisting of partially digested and unassembled material, which can not be evacuated from the stomach. This is often observed in patients with a violation of gastric emptying, which can be caused by operations on the stomach. Many bezoars are asymptomatic, but in some cases signs of obstruction of the outlet of the stomach develop. Some types of bezoars can be subjected to enzymatic dissolution, others require removal by an endoscopic method or surgically.
Partially overcooked accumulations of food of plant origin or hair are called phytobesoares or tricho-bezoars, respectively. Pharmaco-bezoars are a dense accumulation of medicines (especially sucralfate and aluminum hydroxide gel). Various other substances can be found in bezoaras.
[What causes bezoar?
Trichobezoars, which can weigh several kilograms, usually develop in patients with mental disorders who chew and swallow their own hair. Phytobesoares are often found in patients after stomach resections according to Billroth I or II, especially when operations were accompanied by vagotomy. Hypochlorhydria, decreased motility of the antrum and incomplete chewing of food are the main predisposing factors. Other factors include gastric paresis in diabetes and gastroplastic surgery for obesity. Finally, consumption of persimmon (a fruit containing tannin, which polymerizes in the stomach) causes the formation of bezoars, which require surgical treatment in more than 90% of cases. Most often bezoars from persimmons are found in regions where fruit is grown.
Symptoms of bezoar
Most bezoars are not clinically manifested, although after eating, you may experience a feeling of overflow, nausea and vomiting, abdominal pain and gastrointestinal bleeding.
Diagnosis of bezoar
Bezoar is diagnosed as a volumetric formation in an instrumental examination (eg, fluoroscopy, ultrasound, CT of the abdominal cavity ), which is performed to assess symptoms from the upper part of the gastrointestinal tract. They can be mistaken for tumors; endoscopy of the upper gastrointestinal tract is usually performed. With endoscopy, bezoar has a characteristic uneven surface of different colors from yellow-green to gray-black. Endoscopic biopsy is diagnostic and allows you to identify hair or substances of plant origin.
Treatment of bezoar
In the case of diagnosis of bezoar with endoscopy, an attempt to delete it can be made immediately. Fragmentation of the formation by forceps, wire loop, jet 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 strengthen peristalsis and promotes the emptying of the stomach from the fragmented material.
If initially the endoscopic removal was not performed, treatment of bezoar is symptomatic. In the asymptomatic course of the bezoar, which was found accidentally during the study for other indications, no special intervention is required. In some cases, enzyme therapy may be undertaken.
Enzymes include papain (10,000 units per meal), meat tenderers [5 ml (1 teaspoon) in 8 ounces of pure liquid before meals] or cellulose (10 g dissolved in 1 liter of water for 24 hours, 2 -3 days). If enzyme therapy is ineffective or if symptoms are observed, endoscopic removal of the bezoar is indicated. The stony formation density and trihobezoary usually require laparotomy.