This week we are discussing something that doesn’t occur commonly but is interesting nonetheless…Bezoars! What are these odd sounding things? Bezoars are composed of substances that collect in the stomach and struggle to make their way through the digestive tract to the point of excretion. Bezoars aren’t always the result of indigestible food particles but can also come from other ingested material – discussed below.
What causes a gastric bezoar?
Phytobezoars
Phytobezoars are made up of indigestible vegetable and fruit matter (cellulose, hemicellulose, lignin, tannins) that has not moved through the digestive tract as it should. Instead it has collected and become like cement – causing a blockage once it is big enough. These are the most common type of bezoar [1]. Frequent contributors include prunes, grape skin and pineapple.
There is a subclass within this group called diospyrobezoar which is specifically made up of persimmon fibres after excessive intake. The tannins in the fruit skin undergo a process called agglutination which produces a glue like substance once it has come in contact with the stomach acids [1].
Why do some people get bezoars and others don’t?
As previously mentioned, the occurrence of a bezoar is very rare. They tend to come about in people who have poor dentition (hence they can’t adequately break down food), those who have undergone gastric surgery or individuals with digestive issues/ delayed emptying [1].
Lactobezoar
A lactobezoar is extremely rare – since 1959 there have only been around 100 reported cases [2]. It occurs in infants when undigested milk and mucus combine and block the gastrointestinal tract. Symptoms often include; abdominal distention, vomiting, diarrhoea and often respiratory and cardiocirculatory involvement [2].
There are numerous reasons why this might occur and normally it is a combination of factors often seen in pre-term infants with a low birth weight – though it has been reported in toddlers as well [2]. Often it is due to inappropriate milk feeding e.g. hyperconcentrated formula [2]. The infant may have an immature gastrointestinal tract for the composition of their formula (e.g. high caloric and protein content inappropriate for the digestive capabilities of a pre-term infant) and/ or they may have been dehydrated [2].
Pharmacobezoar
These consist of pharmacological matter e.g. tablets, semi-liquid preparations and the vehicles for medication delivery [3]. Once again, this is very rare. In serious cases they have occluded airways. This mainly occurs with excessive intakes [3].
Trichobezoars
Trichobezoars are composed of hair. This can be seen in individuals who have a habit of chewing or sucking on their hair and over a long period of time pieces break off forming a blockage.
Complications of bezoars
When bezoars form they can create what is known as a small bowel obstruction. This is exactly what it sounds like. The foreign matter blocks the intestinal tracts and waste products/ gas cannot pass through. This can be extremely serious if not promptly resolved.
Treatment
The method of treatment will depend on the type of bezoar. For example, trichobezoars are usually surgically removed and lactobezoars are normally managed by making the patient nil by mouth and relying on intravenous fluids and sometimes gastric lavage.
Contact us for results focused nutritional advice
This article was written by our dietitian Belinda Elwin who is a Dietitians Association of Australia member and Accredited Practising Dietitian and Nutritionist. If you have questions about healthy eating, make an appointment. We‘ll provide you with a simple and effective routine targeted to your concerns. Contact us today!
