Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran

Gholamreza Hemmasi; Elahe Zanganeh; Seyed Ashkan Hosseini; Mehdi Alimadadi; Anahita Ahmadi; Shahin Hajiebrahimi; Mohammadreza Seyyedmajidi

Risk factors, endoscopic findings, and treatments in upper gastrointestinal bezoars: multi-center experience in Iran

Gastroenterol Hepatol Bed Bench. 2021 Spring;14(2):160-164.

Authors

Gholamreza Hemmasi¹, Elahe Zanganeh², Seyed Ashkan Hosseini³, Mehdi Alimadadi², Anahita Ahmadi², Shahin Hajiebrahimi², Mohammadreza Seyyedmajidi²

Affiliations

¹ Iran University of Medical Sciences, Tehran, Iran.
² Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran.
³ Mashhad University of Medical Sciences, Mashhad, Iran.

PMID: 33968343
PMCID: PMC8101514

Abstract

Aim: The current study aimed to investigate the risk factors, endoscopic findings, and treatments of upper gastrointestinal bezoars.

Background: Bezoars are compact masses formed by the accumulation of dietary fiber, 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.

Methods: This retrospective study was conducted in three gastroenterology clinics between January 2016 and December 2019. Bezoars were detected in 109 of 15,830 endoscopy records (0.68%).

Results: A total of 103 patients (52.4% male) were enrolled in this study. Mean patient age 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: The synergistic effect of multiple factors for a long time, such as gastrointestinal surgery, diabetes mellitus or psychiatric disorders, may lead to bezoar formation. These risk factors should be avoided or treated in order to prevent bezoar formation and subsequent life-threatening complications.

Keywords: Bezoar; Endoscopic intervention; Risk factors.