Gastric bezoars can give rise to various debilitating symptoms. Affected individuals suffer from delayed gastric emptying, nauseas, vomiting, and early feeling of satiety, anorexia, weight loss, dysphagia and abdominal bloating. About 80% of patients with bezoar suffer from epigastric discomfort [6].

Bezoars which develop in the esophageal route, present with signs and symptoms of odynophagia, retrosternal pain and dysphagia.

Physical examination is of little importance in diagnosing bezoars. However, apparently a palpable mass may be detected during physical exam. However, such finding may be an indication of other conditions and therefore more discrete examination needs to be conducted.

Plain radiographs would help in detection of mass in the abdomen. For more distinct analysis, barium swallow X-ray is indicated. In many instances, endoscopy would also be required for determining bezoars in the esophagus or stomach [7]. In addition, CT scan of the abdomen is also indicated for diagnosing bezoars and identifying associated complications [8].

• The primary goal of treatment of bezoars is their removal and designing preventive strategies to prevent recurrence. Surgical removal of bezoars forms the preliminary basis of treatment regime. Other treatment methods consist of endoscopic fragmentation, dissolution of the bezoars with enzymes such as cellulase or proteolytic enzymes, gastric lavage and dietary modifications with inclusion of more fibrous foods. The mode of treatment employed would largely depend on type and location of the bezoar.
• Majority of the bezoars would require operative removal due to the underlying risks that they carry. Endoscopic methods to remove the bezoars have also achieved considerable amount of success. This mode of treatment is majorly used of trichobezoars. Phytobezoars can be enzymatically removed by dissolving them with various enzymes. Papain, which is a proteolytic enzyme, is also used for removal of phytobezoars.
• An alternative enzyme therapy involving the use of cellulase for dissolving the phytobezoars has been found to be successful. The cellulase enzyme binds the leucoanthocyanidin-hemicellulose-cellulose bonds, which then dissolves the bezoar [9].
• The method of gastric lavage which is done using 3 liters of coca cola beverage over a 12 hour period helps in dissolution of phytobezoars [10]. 

The prognosis of the condition is extremely favorable with full recovery. Medications or surgery can help get rid of the bezoar and individuals can also get prompt relief from the debilitating symptoms [5].

Consumption of substances containing hair or fizzy materials knowingly or unknowingly favors the development of bezoars. The incidence of bezoars is a common occurrence in animals. In humans, it is thought to occur in children or adults with intellectual disability or in those who are suffering from psychiatric illness [2]. Apart from being a common occurrence in this population, bezoars in adult patients occur due to manipulation during operative procedures such as vagotomy and partial gastrectomy [3].

In addition, there are various other predisposing factors that favor bezoar formation. These include disease conditions such as diabetes mellitus, hypothyroidism, Miltonic dystrophy, Guillain-Barré syndrome, cystic fibrosis and intrahepatic cholestasis.

The incidence rate of bezoars in humans is low. Mortality rates associated with the condition is about 30%. The fruit persimmon has been linked to occurrence of bezoars in humans. It has been reported that, excessive consumption of persimmon caused an outbreak of intestinal bezoars. About 90% cases of intestinal bezoars occurred due to high consumption of persimmon.

Animals are known to fall easy prey to this condition. In the past era, in the Middle Ages bezoars were considered as valuable possessions and were frequently used for designing jewelry. 

Bezoars are composed of undigested materials and may contain hair, fiber, medications, food or even chewing gum. These materials do not get digested and as a result also do not pass down the small intestine. Bezoars are more commonly found in the stomach, although they can develop anywhere between the esophagus and rectum.
Individuals with past history of gastric surgery or an altered function of gastric motility, wherein there is significant loss of peristaltic motility, are more prone to develop bezoars [4].

Individuals who have suffered from a bezoar in the past should be careful about its recurrence in future. Parents should be cautious and keep an eye on children who have habit of putting everything inside their mouth. All indigestible materials should be kept out of reach and they should also cut their children’s hair short, so that they can no longer chew their hair.

Indigestible materials may get trapped in the gastrointestinal system. As these are not digested, they do not further pass through the small intestine. Bezoars are of 4 types which have been categorized based on their composition: phytobezoars, trichobezoars, lactobezoars and pharmacobezoars. Phytobezoars constitute of vegetable matter and are the most common form; whereas trichobezoars consists of hair and fiber materials. Lactobezoars primarily consist of undigested milk matter and pharmacobezoars are also known as medication bezoars which form due to certain medications [1].

• Definition: A bezoar is a mass of indigested material that gets accumulated in the gastrointestinal system and give rise to debilitating complications. These comprise of food materials, chewing gum, hair and medications. If these enter the system, they do not get digested and eventually accumulate and form a mass.
• Cause: Consumption of indigestible materials either knowingly or unknowingly gives rise to formation of bezoars. Individuals suffering from psychiatric illness or those who have undergone surgery are more likely to develop bezoars.
• Symptoms: Symptoms of bezoars include delayed gastric emptying, early satiety value, loss of appetite, nausea accompanied by vomiting, weight loss, dysphagia, retrosternal pain and odynophagia. Untreated bezoars can pave way for life threatening complications such as ulceration, necrosis and gastrointestinal bleeding.
• Diagnosis: Physical examination is of little value in diagnosing bezoars. However, a palpable mass during the examination can provide a clue for some underlying problem. In addition, radiographs and barium swallow X-ray can be of considerable help in diagnosing bezoars. CT scan of the abdomen is also indicated.
• Treatment: Surgery or dissolution by enzymes forms the preliminary basis of treatment regime. Surgical removal of the bezoars is one of the most common methods of treating the condition. Dissolution by enzymes such as cellulase or proteolytic enzymes also helps in treatment of bezoars. Use of coca cola beverage in gastric lavage has also achieved considerable amount of success in treating phytobezoars.

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