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Susan Mathison, Published August 22 2012

Mathison: Beware the bezoar: A primer on mystery masses

This is not my usual subject matter, but inquiring minds wanted to know, and I’m here to answer.

I got this message from a reader, “We were talking about bezoars: what they are and how you get them. According to a woman in my Weight Watchers group, her sister got one from eating gummy vitamins.”

My personal experience with bezoars is limited to the neighbor’s cat with a hairball and memories of my Grandma Agnes telling us not to swallow our gum or it would all get stuck together in our stomachs and never come out. This sounded awful, so I never did.

A bezoar is an accumulation, usually made of hair, plant fiber or similar indigestible matter that stays in the gut of a human or animal and forms a hard ball, concretion or “stone.” Historically, bezoars were prized medicinal items because they were believed to have the power of a universal antidote against almost any poison. The word “bezoar” actually comes from the Persian word for antidote.

Harry Potter fans may remember that Ron Weasley was saved from a glass of poison mead when Harry retrieved a bezoar to help. He learned this from Severus Snapes’ first-year Potions class. It was believed that a drinking glass containing a bezoar would neutralize any poison poured into it, though Harry used the “shove-the-bezoar-in-his- throat” method, since they were unaware that Ron’s drink was tainted.

Bezoars are caused by chewing on or eating hair or other indigestible material. Bezoars are rare, found in approximately 1 percent of people who undergo scoping of the stomach for symptoms such as indigestion, nausea, vomiting, diarrhea, pain or gastric ulcers.

Bezoars are classified according to their composition. Phytobezoars, composed of vegetable matter, are the most common type of bezoar. Unripe persimmon fruit accounts for the majority of cases. Trichobezoars, composed of hair, are the next most common and usually occur in young women with psychiatric disorders. Trichotillomania (hair pulling) and trichophagia (hair eating) are usually observed prior to trichobezoar formation.

Pharmacobezoars, composed of ingested medications, have become increasing reported. Examples include extended release nifedipine, theophylline, enteric-coated aspirin, sodium alginate and sucralfate. The above mentioned gummy vitamins would fall into this category.

In a child, it might be possible to feel a firm mass in the stomach. A special X-ray using barium to highlight the mass in the stomach can also be used for diagnosis, or an endoscope could be used to directly view the bezoar and possibly remove it if small.

Larger bezoars usually require surgical removal, but the scientific literature also reports using Coca-Cola and papaya enzyme to dissolve them, or breaking them up with extracorporeal shock wave lithotripsy, the same treatment used for kidney stones.

Other risk factors for bezoar formation are patients who require tube feedings, and those in whom illnesses decrease stomach processing, and increase the time it takes to empty the stomach.

I’m glad I listened to my grandma on the gum issue, and I think I’ll toss the gummy bears.

Let me know if your inquiring mind wants some answers for health, beauty and wellness questions.

Dr. Susan Mathison founded Catalyst Medical Center in Fargo and created PositivelyBeautiful.com. Email her at shesays@forumcomm.com.