Bezoars: A Digestive Dilemma?

My mom (age 70) has developed a bezoar of undigested vegetable matter. She lives on high fiber foods such as kasha, nuts, vegetables and fruit, but her doctor says she can’t have those foods any more. Is there any non-surgical way to break up or get rid of a bezoar, or to be able to eat her favorite foods without making things worse?

– September 25, 2009

Bezoars are accumulations of particulate matter in the intestinal tract. They’re pretty rare. The type you refer to is called a phytobezoar because it consists of undigested residues of plant fiber. Persimmons, because of their high fiber content, are notorious for causing bezoars.

Most bezoars are found in young children and are usually accumulations of hair. Because they often cause no symptoms, we don’t know how frequently they occur. But when symptoms do develop, they typically include abdominal pain, nausea, vomiting, early satiety, foul breath, and weight loss. Sometimes, the abdomen feels tender.

I checked with Gerard E. Mullin, M.D., associate professor of medicine and an integrative gastroenterologist at Johns Hopkins Hospital on treatment of phytobezoars. He says the underlying problem is disordered gastric motility – the stomach doesn’t empty itself normally. Dr. Mullin added that patients with this problem must avoid fruits and vegetables and keep fiber intake low to keep the bezoar from growing.

Treatment usually involves high doses of digestive enzymes or meat tenderizers (like Adolph’s Meat Tenderizer) that contain papain, an enzyme that can help digest fiber. Sometimes, bezoars are removed via endoscopic manipulation, using a viewing device equipped with tiny forceps, which enables the physician to grasp and extract the bezoar through a swallowed tube.

After treatment, it’s important to see a gastroenterologist to learn how to avoid future bezoars, Dr. Mullin said.

Andrew Weil, M.D.

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