Risk factors, endoscopic findings and treatments in upper gastrointestinal bezoars: Multi-center experience
Gastroenterology and Hepatology from Bed to Bench,
,
8 March 2021
https://doi.org/10.22037/ghfbb.v14i2.2010
Abstract
Background and study aim: Bezoars are compact masses that formed by accumulation of high-fiber diet, undigested food, hair or medications. The majority of bezoars are asymptomatic but they may cause serious symptoms or even life-threatening events such as bleeding, obstruction or perforation. We aimed to investigate the risk factors, endoscopic findings and treatments in upper gastrointestinal bezoars.
Patients and methods: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15830 endoscopy records (0.68%).
Results: 103 patients (52.4% male) were enrolled in this study. The mean age of the patients was 60.5±11.3 years. The most frequent risk factors were history of gastric surgery (25.2%), diabetes mellitus (21.3%), hypothyroidism (15.5%), trichophagia (5.8%) and anxiety disorders (2.9%), respectively. The most common endoscopic findings were peptic ulcers (34.9%), erosive gastritis/duodenitis (12.6%) and reflux esophagitis (10.6%). While bezoars were most commonly observed in the stomach (84.4%), the majority of them were phytobezoars (92.2%). The mean number of endoscopic interventions for each patient was 1.5 (range, 1-4). Endoscopy was successful in removing bezoars in 85.4%.
Conclusion: These findings indicated that bezoars are more common among patients with history of gastrointestinal surgery, diabetes mellitus or psychiatric disorders. They are closely related to peptic ulcer and reflux esophagitis and they can be successfully treated with endoscopic interventions.
- Bezoar
- Risk factors
- Endoscopic intervention
References
Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol. 2019 May-Jun;32(3):224-232. doi: 10.20524/aog.2019.0370. Epub 2019 Mar 15. PMID: 31040619; PMCID: PMC6479654.
Gökbulut V, Kaplan M, Kaçar S, Akdoğan Kayhan M, Coşkun O, Kayaçetin E. Bezoar in upper gastrointestinal endoscopy: A single center experience. Turk J Gastroenterol. 2020 Feb;31(2):85-90. doi: 10.5152/tjg.2020.18890. PMID: 32141815; PMCID: PMC7062142.
Khan S, Khan IA, Ullah K, Khan S, Wang X, Zhu LP, Rehman MU, Chen X, Wang BM. Etiological aspects of intragastric bezoars and its associations to the gastric function implications: A case report and a literature review. Medicine (Baltimore). 2018 Jul;97(27): e11320. doi: 10.1097/MD.0000000000011320. PMID: 29979404; PMCID: PMC6076189.
Parakh JS, McAvoy A, Corless DJ. Rapunzel syndrome resulting in gastric perforation. Ann R Coll Surg Engl. 2016 Jan;98(1): e6-7. doi: 10.1308/rcsann.2016.0008. PMID: 26688419; PMCID: PMC5234381.
Khan S, Jiang K, Zhu LP, Khan IA, Ullah K, Khan S, Chen X, Wang BM. Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review. Gastroenterol Res Pract. 2019 Jul 15; 2019:5698532. doi: 10.1155/2019/5698532. PMID: 31396274; PMCID: PMC6664490.
Erzurumlu K, Malazgirt Z, Bektas A, Dervisoglu A, Polat C, Senyurek G, Yetim I, Ozkan K. Gastrointestinal bezoars: a retrospective analysis of 34 cases. World J Gastroenterol. 2005 Mar 28;11(12):1813-7. doi: 10.3748/wjg. v11.i12.1813. PMID: 15793871; PMCID: PMC4305881.
Yaqub S, Shafique M, Kjæstad E, Thorsen Y, Lie ES, Dahl V, Bakka N, Røkke O. A safe treatment option for esophageal bezoars. Int J Surg Case Rep. 2012;3(8):366-7. doi: 10.1016/j.ijscr.2012.04.008. Epub 2012 Apr 24. PMID: 22609703; PMCID: PMC3376689.
Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg. 2018 Oct 20; 13:48. doi: 10.1186/s13017-018-0208-z. PMID: 30377439; PMCID: PMC6196030.
Altintoprak F, Degirmenci B, Dikicier E, Cakmak G, Kivilcim T, Akbulut G, Dilek ON, Gunduz Y. CT findings of patients with small bowel obstruction due to bezoar: a descriptive study. Scientific World Journal. 2013 Apr 18; 2013:298392. doi: 10.1155/2013/298392. PMID: 23690741; PMCID: PMC3654257.
Manning EP, Vattipallly V, Niazi M, Shah A. Phytobezoar Induced Small Bowel Obstruction in a Young Male with Virgin Abdomen. J Gastrointest Dig Syst. 2015;5(2):266. doi: 10.4172/2161-069X.1000266. Epub 2015 Mar 25. PMID: 29795770; PMCID: PMC5962263.
Mihai C, Mihai B, Drug V, Cijevschi Prelipcean C. Gastric bezoars diagnostic and therapeutic challenges. J Gastrointestin Liver Dis 2013; 22:111. PMID: 23539409.
Park SE, Ahn JY, Jung HY, Na S, Park SJ, Lim H, Choi KS, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH. Clinical outcomes associated with treatment modalities for gastrointestinal bezoars. Gut Liver. 2014 Jul;8(4):400-7. doi: 10.5009/gnl.2014.8.4.400. Epub 2014 Jan 14. PMID: 25071905; PMCID: PMC4113045.
Koulas SG, Zikos N, Charalampous C, Christodoulou K, Sakkas L, Katsamakis N. Management of gastrointestinal bezoars: an analysis of 23 cases. Int Surg 2008; 93:95-8. PMID: 18998288.
Hewitt AN, Levine MS, Rubesin SE, Laufer I. Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol 2009; 82:901-7. DOI: 10.1259/bjr/15256968 PMID: 19433488
Akrami M, Sasani MR. Dietary Habits Affect Quality of Life: Bowel Obstruction Caused by Phytobezoar. Iran J Public Health. 2016 Aug;45(8):1080-1082. PMID: 27928535; PMCID: PMC5139966.
Prasad A, Jain A, Gupta A, Kamra A. Trichobezoar: Ravenous for Hair. Euroasian J Hepatogastroenterol. 2018 Jan-Jun;8(1):97-98. doi: 10.5005/jp-journals-10018-1271. Epub 2018 May 1. PMID: 29963475; PMCID: PMC6024051.
Kumar Bn A, Kumar L N, Thippeswamy J, Rangaswamaiah LN. Trichobezoar (Rapunzel syndrome) in an adolescent patient with Trichotillomania and Generalized Anxiety Disorder: A case report. Asian J Psychiatr 2016; 23:44-5. DOI: 10.1016/j.ajp.2016.07.008. PMID: 27969077.
Kumar R, Anand U. An unusual case of large gastro-duodenal bezoars. Med J Armed Forces India. 2016 Oct;72(4):406-407. doi: 10.1016/j.mjafi.2016.08.005. Epub 2016 Oct 17. PMID: 27843195; PMCID: PMC5099446.
Kement M, Ozlem N, Colak E, Kesmer S, Gezen C, Vural S. Synergistic effect of multiple predisposing risk factors on the development of bezoars. World J Gastroenterol. 2012 Mar 7;18(9):960-4. doi: 10.3748/wjg. v18.i9.960. PMID: 22408356; PMCID: PMC3297056.
Iwamuro M, Yunoki N, Tomoda J, Nakamura K, Okada H, Yamamoto K. Gastric Bezoar Treatment by Endoscopic Fragmentation in Combination with Pepsi-Cola® Administration. Am J Case Rep. 2015 Jul 10; 16:445-8. doi: 10.12659/AJCR.893786. PMID: 26164451; PMCID: PMC4504408.
Szor DJ, Dias AR. Gastric trichobezoar. Clin Case Rep. 2017 Sep 29;5(11):1907. doi: 10.1002/ccr3.1213. PMID: 29152300; PMCID: PMC5676274.
Kajal P, Bhutani N, Tyagi N, Arya P. Trichobezoar with and without Rapunzel syndrome in paediatric population: A case series from a tertiary care centre of Northern India. Int J Surg Case Rep. 2017; 40:23-26. doi: 10.1016/j.ijscr.2017.08.060. Epub 2017 Sep 8. PMID: 28918296; PMCID: PMC5602516.
- Abstract Viewed: 0 times
