Introduction:
Digestion is an important process by which the body absorbs nutrients and provides energy to cells. The capacity of the body to digest food varies from person to person. Sometimes, individuals may experience indigestion or accumulate undigested substances called bezoars. These substances may obstruct the digestive tract, resulting in complications.
What Is a Digestive System?
The body is made of different cells, each specific to an organ. A group of organs performing the same function are called an organ system. For example, the digestive system primarily functions by breaking down the consumed food into smaller particles which are made available to the body to provide nutrition and energy.
What Are the Parts of the Digestive System?
The digestive system comprises the following parts:
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Mouth.
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Esophagus.
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Stomach.
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Small intestine.
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Large intestine.
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Anus.
In addition, organs like the liver, pancreas, and gallbladder provide digestive enzymes and aid digestion.
What Is Digestion?
Digestion is the process of breaking down molecules and food substances into their simpler form. The body utilizes these for energy, growth, and cell repair. Digestion creates solid wastes, which are eliminated from the body as feces.
What Are the Steps Involved in Digestion?
The stages of digestion are mentioned below:
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Ingestion: The process in which the food enters the mouth via the digestive system is called ingestion. First, the food is chewed in the mouth to form a bolus, which is moved from the mouth to the esophagus with the help of saliva. Saliva is produced by the salivary glands, which help in digestion.
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Propulsion: The ingested food is processed to form a bolus that moves through the digestive tract to reach the stomach. This process is called propulsion, aided by the action of muscles in the digestive tract that propels the food forward.
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Mechanical Digestion: In mechanical digestion, food is broken down into smaller particles to undergo chemical digestion effectively. Mechanical digestion involves chewing and mashing food.
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Chemical Digestion: Chemical digestion is the process of further breakdown of fluid by the action of digestive juices and enzymes for better absorption.
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Absorption: The body absorbs nutrients from the food, which are circulated to the rest of the body to provide energy to cells.
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Defecation: After the digestive process, any remains of undigested food are expelled from the body along with metabolic waste products in the form of stool. This process is called defecation.
Where Are Bezoars?
Bezoars are masses of inedible or indigestible food substances that are commonly accumulated in the stomach and intestine.
What Are the Types of Bezoars?
Bezoars can be classified into various types depending on their composition, which are mentioned below:
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Lactobezoars: Lactobezoars are an accumulation of milk proteins and mucus. It is found in milk-fed infants and results in obstruction of the gastric outlet.
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Phytobezoars: Phytobezors are components of indigestible plant materials like fibers and seeds. They are commonly found in fruits and vegetables.
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Trichobezoars: Trichobezoars are hair-like structures that are undigested and are trapped in the stomach. It is also called Rapunzel syndrome. In trichobezoar, a hairball is formed, which has a long tail extending from the stomach to the small intestine.
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Pharmacobezoars: Pharmacobezoars are a ball of undigested drugs that obstruct the gastrointestinal tract. It occurs due to improper dissolution of the medications in the digestive tract.
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Foreign Body Bezoars: Foreign body bezoars are composed of parasitic worms and harmful substances like paper, plastics, and foam cups which the body cannot digest.
What Is the Etiology of Bezoars?
The formation of bezoars is usually a result of a malfunction of the gastrointestinal tract in terms of digestion and propulsion of some materials. Possible causes of this disruption may be changes in motility within the gastrointestinal tract, changes in the chemical environment in the stomach, or some form of blockage within the digestive system. Patients with slow-moving stomachs, slow gastric emptying, or any sort of gastrointestinal disease are vulnerable to bezoar formation.
What Are the Causes of Bezoars?
Bezoars can affect any individual and are caused due to the build-up of substances in the gastrointestinal tract that cannot be digested by the stomach.
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Dietary Habits:
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Phytobezoars: These are the most common kind and are created from indigestible plant fiber, which happens to be identified to originate from persimmons, oranges, celery, and coconuts. Intake of large amounts of fibrous foods that are not well chewed or in the presence of slow gastric motility leads to the formation of these fibers into a bezoar.
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Trichobezoars: Often observed in people with trichophagia, a hair-eating disorder, these bezoars are comprised of hair that is ingested and cannot be metabolized easily. Gradually, this hair accumulates in the stomach, forming a mass.
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Lactobezoars: These are mainly found in babies who are fed with concentrated milk formulas, which leads to the deposition of milk proteins that form a solid mass.
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Medications:
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Pharmacobezoars: Some of the drugs that are slow dissolving or have poor absorption characteristics are capable of accumulating and thus forming bezoars. These are, for instance, extended-release tablet forms, antacids, and bulk-forming types of laxatives.
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Previous Gastric Surgery: Patients who have been operated on for partial gastrectomy or who have had gastric bypass surgery are at higher risk. Such surgeries may also affect the motility of the stomach, which gives the stomach less ability to grind and expel content, hence allowing the formation of undigested materials.
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Gastrointestinal Disorders: Diseases that may slow down stomach emptying include gastroparesis, diabetes mellitus, and hypothyroidism, in which food takes a long time to pass through the stomach, hence increasing the chances of bezoar formation.
What Are the Symptoms of Bezoars?
Bezoars usually do not show signs or symptoms as they do not completely obstruct the gastrointestinal tract. However, some symptoms of bezoars are mentioned below:
What Are the Risk Factors Associated With Bezoars?
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Impaired Gastric Motility: One of the greatest risks associated with bezoar formation is decreased gastric motility, which can be attributed to diseases such as diabetes, scleroderma, or nerve damage. Although the passage of food through the digestive tract to elimination is normal, sometimes the food is not well churned, and it forms bezoars.
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Inadequate Mastication: Habits such as inadequate mastication, especially in patients with dental problems or the consumption of large amounts of fiber-rich foods, predispose one to the development of phytobezoar.
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Behavioral Conditions: Other psychiatric diseases that put a person at risk of developing trichobezoars include trichotillomania (hair-pulling disorder) and pica (consumption of inedible objects).
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Certain Medications: Bezoar formation has been reported with long-term use of drugs that slow gastric motility, such as anticholinergic and opioids.
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Dehydration: Dehydration causes a decrease in the amount of water in the gastrointestinal tract, and subsequently, the undigested materials harden to form bezoars.
Age and Infancy: Bezoars are more frequent in infants, specifically lactobezoars, because of their physiologically less developed gastrointestinal tracts and the consumption of concentrated or thickened milk formulas. Anyone who might have problems with the motility of the stomach or with the brain will also be at high risk.
What Are the Complications of Bezoars?
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Bezoars can affect the inner lining of the digestive tract and may occasionally cause bleeding. This causes blood tinges in the stool.
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It may cause intussusception, a condition in which a parts of the intestine slide into one another. This is called telescopic action. Intussusception may damage and block the blood supply. Rarely it may cause necrosis (death) of the intestine, which may be fatal if left untreated.
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Rarely, bezoars may perforate the digestive tract leaking intestinal contents like processed food, digestive juices, and stool into the abdomen. This results in inflammation of the abdominal cavity. As a result, the individual may experience severe abdominal pain, which may radiate to the shoulders. It also causes illness, increases heart rate, and causes sweating.
Are Bezoars Fatal?
Bezoars are found in the stomach and small intestine. Large bezoars may completely obstruct the digestive tract and become fatal if undiagnosed.
How Are Bezoars Diagnosed?
Most bezoars are asymptomatic and are diagnosed with x-rays and imaging techniques that help visualize the digestive tract. Some of the methods used to diagnose bezoars are mentioned below:
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X-rays: X-rays produce images of structures inside the body, especially the bones.
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Abdominal Ultrasound: Abdominal ultrasound helps to image the internal structures of the abdominal cavity through sound waves.
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CT Scan: Computed tomography (CT) is an imaging technique that produces images of the intestine to identify solid structures.
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Endoscopy: Endoscopy is a test done using an endoscope. An endoscope is a medical equipment that has a tube with a camera attached to the end that helps to produce images of the body. Bezoars appear as mass lesions in endoscopy.
How Are Bezoars Treated?
The treatment of bezoars depends on the severity of the condition. In case of mild symptoms, medications may be prescribed to dissolve bezoars, which are broken down and naturally eliminated from the body. Larger bezoars may require surgical excision.
Conclusion:
Bezoars are digestive disorders formed due to the accumulation of indigestible substances in the digestive tract. Bezoars are of various types depending on their composition. Although bezoars are usually asymptomatic, early diagnosis and prompt treatment help in efficient digestion and quality of life
