Gastrointestinal symptoms in anorexia nervosa

TLDR

Gastrointestinal symptoms in anorexia nervosa and their response to refeeding are poorly understood. The study aimed to determine whether gastrointestinal symptoms improve during refeeding, to characterize their type and frequency, and to develop guidelines for testing and intervention. Sixteen anorexia nervosa patients were evaluated on 12 gastrointestinal symptoms before and after nutritional rehabilitation, with follow‑up throughout treatment, and gastrointestinal testing was reserved for those who failed to gain weight or showed signs of independent digestive disease. All patients reported multiple gastrointestinal symptoms at admission, and nearly all improved during refeeding, with significant gains in appetite, bloating, constipation, vomiting, and diarrhea, and none required invasive testing or medication.

Abstract

Neither the natural history of gastrointestinal symptoms in patients with anorexia nervosa nor their response to refeeding have been well studied. We hypothesized that gastrointestinal symptoms in anorexia nervosa will decrease during refeeding despite high caloric intake, suggesting that delayed gastric emptying, where present, is a result rather than a cause of anorexia nervosa. Study goals were (a) to determine the type and frequency of gastrointestinal symptoms, (b) to follow symptoms during refeeding prospectively, and (c) to develop guidelines for gastrointestinal testing and intervention in hospitalized anorectic patients. Sixteen consecutive patients with anorexia nervosa were rated on 12 gastrointestinal symptoms before and after nutritional rehabilitation and followed up throughout treatment. All patients reported multiple gastrointestinal symptoms on admission; all symptoms except belching improved during treatment despite large calorie increases (p less than 0.0002); significant improvements occurred in appetite, bloating, constipation, vomiting, and diarrhea; and no patients required endoscopy, x-ray evaluation, or antipeptic regimens. We conclude that although severe gastrointestinal symptoms are common in anorexia nervosa, they improve significantly with refeeding. Specific gastrointestinal studies should be reserved for patients who do not gain weight or who have indications of independent digestive disease.