• The peak age of onset reported in the literature is 10 to 19 years.
• Ninety percent of patients reportedly are women.

• Trichobezoars: patient’s own hair
• Phytobezoars: indigestible fruit and vegetable matter
• Lactobezoars: milk
• Foreign bodies
• Fungal
• Less common materials include vitamins, antacids, psyllium, sucralfate, cimetidine, and nifedipine.

• Associated with trichotillomania and trichophagia
• Bezoars may become large and form a cast of the stomach.
• The bezoar may extend through the pylorus into the small bowel. This “tail” may obstruct the papilla of Vater, leading to jaundice and pancreatitis.

• Most common form among adults
• Associated with gastric dysmotility and poor gastric emptying (either primary or following gastric surgery) and hypochlorhydria
• Composed primarily of cellulose, hemicellulose, lignins, and tannins

• Factors contributing to lactobezoar formation include:
  • Formulas with a high casein content
  • Early and rapid feeding advancement in small infants
  • High-caloric-density formulas
  • Formulas with high calcium/phosphate content
  • Continuous tube feedings
  • Altered gastric motility in low-birth-weight infants

• Pain
• Nausea
• Vomiting
• Diarrhea
• Gastric ulceration
• Upper gastrointestinal bleeding and perforation

• Unusual patterns of balding
• Palpable left upper quadrant mass in the abdomen is often detected.

• Iron-deficiency anemia, steatorrhea, or protein-losing enteropathy
• Plain abdominal radiography of the abdomen
• Upper gastrointestinal studies may outline the mass.
• Endoscopy may provide both the diagnosis of the specific type of bezoar and a method of treatment through fragmentation with biopsy forceps or snares.

• Diet alteration
• Medications such as prokinetic agents to stimulate gastric motility
• Enzyme therapy to help dissolve the material
• Acetylcysteine treatment via nasogastric tube has been documented in one case report.
• Papain has shown to be approximately 87% effective. (Papain tablets are not currently available in the United States, so monosodium glutamate [MSG] dissolved in clear liquids has been used.) Complications of this therapy include the development of gastric ulceration and hypernatremia secondary to the high sodium content of MSG.
• Endoscopic fragmentation or extraction
• Surgical extraction

• Withholding feedings for approximately 48 hours while the patient is sustained on IV fluids

Q: What are some commonly used medications that can lead to bezoar formation?
A: Vitamins, antacids, psyllium, sucralfate, cimetidine, and nifedipine.

Q: What may place an infant at risk for formation of a bezoar?
A: The literature suggests that formulas with a high casein contact may be linked with lactobezoar formation. Other possible contributing factors include early and rapid feeding advancement in small infants, high-density formulas, formulas with high calcium/phosphate content, continuous tube feedings, and altered gastric motility in low-birth-weight infants.