GI Disorders May Signal Underlying Eating Disorders

Gastrointestinal tract symptoms can be the first physical signs of an eating disorder. And, in fact, patients often see their physician for GI problems long before an eating disorder is suspected. Two recent studies underscore the benefits of the “GI messenger.”

A case of achalasia that mimicked anorexia nervosa

Achalasia, an esophageal disorder that induces vomiting, can lead to cachexia if not detected early. And, in a report from the United Kingdom, the symptoms of achalasia, which include avoidance of food as well as vomiting, may mimic those of anorexia nervosa (AN). Drs. P.J. Goldsmith and B. Decadt recently reported a case of extreme achalasia in an 18-year old woman (Case Reports in Surgery 2012; 985454-6.).

Largely on the strength of her GI symptoms, the A student was diagnosed with AN and sent for psychiatric evaluation. The woman had uncontrolled vomiting after meals, as well as weight loss and hypokalemia. Despite her efforts, she could not regain her lost weight. The vomiting episodes had begun 4 years earlier, but several studies, including a gastroscopic examination, produced normal resultsl. Her “eating disorder” was traced to being teased about weight as a child and bullying by her mother for being overweight. Her mother and father had separated soon after her eating disorder was diagnosed. Her body mass index (BMI) was 13.3 kg/m² . Eventually the narrowing of the esophagus was detected, and the patient had a laparoscopically placed feeding tube. After this she began regaining weight until her BMI reached 22.

The authors note that when a patient presents with persistent vomiting but also sincerely wishes and attempts to gain weight without success, the diagnosis of an eating disorder should be delayed until all physical possibilities are first ruled out.

A second study of functional dyspepsia and eating disorders

In a second study, a team at the University of Salerno, Italy, evaluated functional dyspepsia disorders among female patients with eating disorders, those with constitutional thinness (CT), and a group of age- and gender-matched healthy volunteers (World J Gastroenterol 2012; 18:4379-4385). Dr. Antonella Santonicola and her fellow researchers used a structured questionnaire to gather demographic and anthropomorphic data from 20 patients with AN, 6 with bulimia nervosa (BN), 10 with eating disorders not otherwise specified (EDNOS), 9 CT subjects, 32 obese patients, and 22 healthy volunteers. The presence of functional dyspepsia and subgroups, including epigastric pain syndrome and the postprandial distress syndrome (PDS) were diagnosed according to the Rome III criteria.

Results

The diagnosis of PDS was very common among women who had AN, BN, and EDNOS. Those with BN and EDNOS had high scores for postprandial fullness, epigastric pressure and nausea, whereas AN patients shared with BN patients an increase in postprandial fullness, but also demonstrated prominent early satiety. Obese patients were nearly asymptomatic in regard to functional dyspepsia.

The authors note that the hallmarks of an eating disorder are clinical disturbances in body image and eating behavior, resulting in physical and psychological impairment. Patients with AN often complain of GI symptoms that seem to point to disordered gastric motility, especially when they are in the refeeding phase. In this study, the more prevalent and intense dyspeptic symptoms were epigastric fullness and abdominal distention, which patients may use as an argument for refusing food. Among bulimic patients, the large amounts eaten during a binge not only lead to a loss of control but also to a sensation of epigastric distention and early satiety. The latter two symptoms are halted by self-induced vomiting, which allows either continuation or termination of the binge.

The authors felt it was noteworthy that the obese patients showed no binge-eating behavior, suggesting that eating patterns per se rather than overall caloric intake, are more closely linked to generation of symptoms in the GI tract. Another novel finding was that 55% of the CT subjects met Rome III criteria for PDS and had a higher-intensityfrequency score for early satiety than did healthy volunteers.

The authors also felt that a large number of individuals presenting for medical treatment for GI symptoms in gastroenterology outpatient clinics could be better managed by first identifying the problem and then by receiving adequate treatment for concurrent eating disorders. This is an important issue, they say, given that the ultimate goal of therapy for persons with suspected eating disorders is normalization of gastric behavior, enabling the patient to return to her normal life.