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home - Stomach - Gastric Polyps and Masses - Gastric Bezoars Written by Dr Sebastian Zeki

Gastric Bezoars

Types of Bezoars Phytobezoars They are omposed of vegetable matter.It is the most common type of bezoar.The diospyrobezoar (persimmon fruit) accounts for the majority of cases.Lupini beans, used by healers to treat arthritic pain, have also formed a bezoar. Trichobezoars They are composed of hair, esp. in young women with psychiatric disorders.Rapunzel syndrome is a trichobezoar with a long tail extending into small bowel- this occurs almost exclusively in young girls. Pharmacobezoars They are composed of ingested medications eg extended release nifedipine, theophylline, enteric-coated aspirin, sodium alginate, and sucralfate. Other BezoarsThese include milk curd, tissue paper, shellac, fungus, Styrofoam cups, cement, and vinyl gloves. Pathogenesis It is rare in healthy subjects.80% have a history of gastric surgery.75% have undergone vagotomy and pyloroplasty.Formation is probably not solely related to decreased gastric emptying.Bezoars grow by the continuing ingestion of food rich in cellulose and other indigestible materials such as hair, cotton, and tissue paper, matted together by protein, mucus, and pectin. The pathogenesis of the persimmon bezoar (diospyrobezoar) is well understood. The unripe fruit contains high concentrations of a soluble tannin called shibutol, which forms a coagulum when mixed with acid (as occurs in the stomach). Many patients form diospyrobezoars without gastric dysfunction. Trichobezoars begin as retained hairs between the gastric foldsThe hair is then denatured by gastric acid, becomes black (regardless of hair color) and combines with food to form an enmeshed mass.Trichobezoars become colonized by bacteria resulting in a foul smell. Pharmacobezoars occur in a variety of circumstances with the major predisposing factors being gastric dysfunction and the properties of the particular drug. As examples:Bowel hypoactivity, dehydration, and the concomitant use of anticholinergic agents and opiates contribute to the propensity for bezoar formation in patients with renal failure treated with aluminum hydroxide. Sucralfate bezoars typically occur in patients with gastric outlet obstruction. Bezoars composed of magnesium and calcium carbonate may be seen when compressed tablets are given to patients with achlorhydria. Insolubility of the carrying vehicle is the major contribut-ing factor to bezoar formation with enteric-coated aspirin and nifedipine. The hydroscopic properties of psyllium and wheat dextrin contribute to the propensity of these compounds to form bezoars. Gastric bezoars Definition: Foreign ingested material in the form of masses or concretions. Clinical FeaturesFor males the average age of onset is 40-50.For females the average age of onset is in the20’s.Symptoms develop insidiously or suddenly.GI bleeding is common (ulceration).Can rarely get drug overdose from a pharmacobezoar. Diagnosis— CT/ Barium/ OGD TreatmentVaious methods include: Chemical dissolution, endoscopy, and surgery.Phytobezoars can be chemically dissolved- but trichobezoars can’t so have to be endoscopically/ surgically removed.Medical therapy can be used for phytobezoars esp if endoscopy cant remove.Cellulase can be used to digest plant material found in the mass.Papain is given in the form of Adolph's Meat Tenderizer, 1 teaspoon in 120 mL of water before each meal.Acetylcysteine is instilled, 15 mL in 50 mL of water, via NG tds.Coca-Cola has anecdotal evidence for its efficacy.Endoscopy can be used to fragment with water jet and suction/ snare/ basket or pass through GI tract.Surgery is a last resort if the patient is bleeding or the bezoar can’t be removed. Written by Dr Sebastian Zeki

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