Hamza Khan, MD1, Ahmed Shah, MD1, Shahzaib Zindani, MD2, Khawaja Rahman, MD3 1Midwestern University, Cottonwood, AZ; 2The Ohio State University, Toledo, OH; 3Verde Valley Medical Center, Cottonwood, AZ Introduction: Phytobezoars are rare, indigestible plant fiber aggregates typically found in the stomach. Though more often associated with obstruction, they are an underrecognized cause of upper gastrointestinal bleeding (UGIB), especially in elderly or high-risk patients.
Case Description/
Methods: An 84-year-old man with atrial fibrillation on warfarin, HFrEF (EF 20–25%), CAD, AAA, and prior CVA presented with fatigue, hypotension, and melena. He was pale and hypotensive (BP 74/46 mmHg), requiring ICU admission for hemorrhagic shock. Labs showed Hgb 8.0 g/dL and INR 2.3. He received PRBCs and FFP. EGD on day 1 revealed a large gastric cardia phytobezoar with bleeding at the gastroesophageal junction and LA Grade A esophagitis. The bezoar was removed endoscopically.
Post-procedure, he developed respiratory failure due to left-sided whiteout and mucus plugging, requiring intubation and vasopressors. He improved with bronchoscopy and was treated for aspiration pneumonia. A modified barium swallow confirmed aspiration; a dysphagia diet was initiated. He was transitioned to the medicine floor with palliative support.
Discussion: Phytobezoars can cause UGIB via pressure-induced ulceration, particularly in elderly or gastroparetic patients. Up to 82% of bezoars are associated with mucosal ulceration, with nearly half presenting with overt bleeding. Endoscopy is key for diagnosis and therapy. Bleeding severity does not correlate with bezoar size or duration. Early intervention, including endoscopic removal and follow-up, is crucial. Risk reduction strategies include dietary changes and prokinetic therapy.
Figure: Images of Gastric Bezoar found in Gastric Cardia, noted to have been the cause of GI Bleed
Disclosures: Hamza Khan indicated no relevant financial relationships. Ahmed Shah indicated no relevant financial relationships. Shahzaib Zindani indicated no relevant financial relationships. Khawaja Rahman indicated no relevant financial relationships.
Hamza Khan, MD1, Ahmed Shah, MD1, Shahzaib Zindani, MD2, Khawaja Rahman, MD3. P3104 - Phytobezoar-Related GI Hemorrhage in the Elderly: An Underrecognized Cause of Upper GI Bleeding, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
