Bezoars are partially or undigested masses that can form in the stomach. There are several types, including phytobezoars made of plant matter, trichobezoars made of hair, and pharmacobezoars made of medications. Trichobezoars commonly form in patients with psychiatric issues who chew and swallow their hair. Phytobezoars often occur after gastric surgery that reduces stomach acid. Bezoars may cause symptoms like nausea, but many are asymptomatic. Endoscopy can detect and sometimes remove bezoars. Treatment depends on symptoms and can include observation, enzymes to dissolve them, or endoscopic or surgical removal.

1. Bezoars.
Partially digested agglomerations of vegetable matter are
called phytobezoars; agglomerations of hair are called
trichobezoars. Pharmacobezoars are concretions of
medication (particularly common withsucralfate and
aluminum hydroxide gel). Many other substances have
been found in bezoars.
Etiology
Trichobezoars, which can weigh several kg, most commonly occur in
patients with psychiatric disturbances who chew and swallow their
own hair. Phytobezoars often occur in patients who have undergone
a Billroth I or II partial gastrectomy, especially when accompanied by
vagotomy. Hypochlorhydria, diminished antral motility, and
incomplete mastication are the main predisposing factors; these
factors are more common among the elderly, who are thus at higher
risk of bezoar formation. Others include diabetic gastroparesis and
gastroplasty for morbid obesity. Consumption of persimmons (a fruit
containing the tannin shibuol, which polymerizes in the stomach) has
been known to cause bezoars that require surgery in > 90% of cases.
Persimmon bezoars often occur in epidemics in regions where the
fruit is grown.
Symptoms and Signs
Most bezoars cause no symptoms, although postprandial fullness, nausea and
vomiting, pain, and GI bleeding may occur.
Diagnosis
• Endoscopy
Bezoars are detectable as a mass lesion on most tests (eg, x-ray, ultrasound, CT) that
may be done to evaluate upper GI symptoms. They may be mistaken for tumors;
upper endoscopy is usually done. On endoscopy, bezoars have an unmistakable
irregular surface and may range in color from yellow-green to gray-black. An
endoscopic biopsy that yields hair or plant material is diagnostic.

2. Treatment
• Observation
• Sometimes manual removal via endoscopy
• Sometimes enzymatic therapy
If initial diagnosis is made by endoscopy, removal can be attempted
at that time. Fragmentation with forceps, wire snare, jet spray, or
even laser may break up bezoars, allowing them to pass or be
extracted.
If endoscopy was not initially done, treatment is based on symptoms.
Asymptomatic patients that have a bezoar discovered incidentally
during testing for other reasons do not necessarily require
intervention. In some cases, a trial of enzymatic therapy can be
attempted. Enzymes include papain (10,000 U with each meal), meat
tenderizer (5 mL [1 tsp] in 8 oz of clear liquid before each meal), or
cellulase (10 g dissolved in 1 L water, consumed over 24 h for 2 to 3
days). If enzymatic therapy is unsuccessful, or if patients are
symptomatic, endoscopic removal may be tried. Rocklike concretions
and trichobezoars usually require laparotomy
Conclusion: bezoar is a tightly packed collection of partially
digested or undigested material that is unable to exit the stomach.
It often occurs in patients with abnormal gastric emptying,
especially those that have diabetic gastroparesis, as well as after
gastric surgery. Many bezoars are asymptomatic, but some cause
symptoms of gastric outlet obstruction. Some can be dissolved
enzymatically, others removed endoscopically, and some require
surgery.