A False Report of Bulimia Nervosa

Sometimes what first appears to be an eating disorder turns out to be something else. For example, the signs and symptoms of eating disorders and certain gastrointestinal disorders can be similar, leading to a false diagnosis of an eating disorder. This was underscored by a recent case reported by Marie L. Borum, MD, MPh and Eashen Liu, MD, of George Washington University, Washington, DC (Prim Care Companion J Clin Psychiatry 2006;8:5).

A 25-year-old woman with a history of bulimia nervosa (BN) was referred for a second opinion after a preliminary consultation with her primary care physician. The woman had episodes of vomiting that resulted in an unintentional weight loss of about 25 lb. Initial tests showed no unusual findings and her primary care physician and gastroenterologist suspected her eating disorder had recurred.

When she was reexamined, the patient complained of nausea, vomiting and early satiety. She denied having depression, a distorted body image or sleep disturbances. She also had no abdominal pain or diarrhea. The patient was 5’6″ tall and weighed 100 lb. Colonoscopy was normal and all symptoms seemed to point to a recurrence of BN.

The true diagnosisCrohn’s diseasewas only made after an upper endoscopy revealed pyloric stricture and biopsy samples showed noncaseating granulomas. The authors note that recurrent vomiting and unhealthy weight loss are symptoms that could describe either an eating disorder or duodenal Crohn’s disease. When evaluating a young person for an eating disorder, they suggest adding the possibility of Crohn’s disease or another gastrointestinal disease to the differential diagnosis.