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A bezoar is a concretion of indigestible material that accumulates within the gastrointestinal (GI) tract, most commonly in the stomach or small intestine, resulting in mechanical obstruction or mucosal irritation.

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The term derives from the Arabic bāzahr, meaning “antidote,” as bezoars were historically believed to neutralize poisons.

Classification

Type	Composition / Material	Common Site	Characteristic Features
Phytobezoar	Undigested vegetable/fruit fibers (e.g., cellulose, lignin from persimmon, orange, celery)	Stomach (most common)	Most frequent type; may extend to small bowel
Trichobezoar	Hair (usually in trichotillomania/trichophagia)	Stomach ± small bowel	Young females; “Rapunzel syndrome” if extends into small intestine
Pharmacobezoar	Medications (antacids, sucralfate, enteric-coated tablets)	Stomach	Common in patients with delayed gastric emptying
Lactobezoar	Milk curd (protein + fat)	Neonates, preterm infants	From concentrated milk formula or dehydration
Diospyrobezoar	Persimmon fruit fibers + tannins forming phytobezoar subtype	Stomach	Hard, resistant to dissolution
Others (rare)	Plastic, paper, resin, shellac, etc.	Variable	Post ingestion of foreign substances

Etiopathogenesis

Predisposing Factors:

Gastric surgery (partial gastrectomy, vagotomy, pyloroplasty → reduced motility).
Delayed gastric emptying (e.g., diabetes mellitus, hypothyroidism).
Psychiatric disorders (trichotillomania, pica).
High-fiber diets (especially persimmon ingestion).
Poor mastication (edentulous patients).
Dehydration / hypochlorhydria.

Pathophysiology:

Indigestible material accumulates in the stomach.
Gastric motility impairment prevents clearance.
Aggregation with mucus and food → concretion formation.
May enlarge and migrate to small bowel causing obstruction.

Classification

Etiopathogenesis

Clinical Presentation