To analyze the clinical characteristics and gastroscopic features of bezoar versus gastric ulcer to guide their clinical diagnosis and treatment.

Patients who were diagnosed with bezoar by gastroscopy or abdominal CT from October 2014 to March 2023 were included as cases, while those diagnosed with gastric ulcer by gastroscopy were included as controls. Statistical analyses were performed for comparisons between the two groups in terms of demoimagedata characteristics, clinical features, gastroscopic features, etc.

Bezoars were more common in females and prevalent in the autumn and winter seasons, and hawthorn bezoar was more common in north regions. Gastric ulcers were more common in males. Bezoars combined with diabetes (36.1%) were more common than gastric ulcers combined with diabetes (25.2%), while history of smoking, alcohol consumption, and history of taking NSAIDs were more common in patients with gastric ulcer. Abdominal pain (85.8%) was the most common symptom in patients with bezoar. The most common complication of bezoar was peptic ulcer (68.4%). Bezoar-induced ulcers were mostly multiple, with an average length of (15.94 ±11.92) mm, of which 32.4% were≥20 mm in length, and the ulcers were superficial, healed easily, and were prevalent in the gastric angle. Gastric ulcers were mostly solitary, with a mean length of (10.44 ± 7.78) mm, of which 13.1% were≥20 mm in length, and the ulcers were prevalent in the gastric sinus.

Bezoars are more frequent in females and in patients with combined diabetes mellitus, and digestive system symptoms such as abdominal pain and nausea are more common in bezoars than in gastric ulcers. The combination of gastroscopic and imaging features can help diagnose bezoars as early as possible to prevent the development of complications such as intestinal obstruction.