In this case report, the authors describe an esophageal bezoar found in a mechanically ventilated patient receiving sucralfate, antacid, and tube feeding via a nasogastric tube. The presence of a prosthetic device in the esophagus (such as a nasogastric or endotracheal tube) in conjunction with functional esophageal abnormalities is a common link in the development of esophageal bezoars. These bezoars form in the esophagus as a result of regurgitation of stomach contents. In addition, bezoars are a known complication of gastric motility disorders, such as gastric paresis of diabetes. Critically ill patients are frequently given antacid and sucralfate therapy while being enterally tube fed, often by nasogastric tubes. This combination of treatment modalities in patients with esophageal and/or neurological abnormalities warrants vigilant adherence to measures to prevent reflux and gastric pooling.