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Di Giorgio FM, Modica SP, Saladino M, Muscarella S, Ciminnisi S, Almasio PL, Petta S, Cappello M. Food Beliefs and the Risk of Orthorexia in Patients with Inflammatory Bowel Disease. Nutrients 2024; 16:1193. [PMID: 38674883 PMCID: PMC11054879 DOI: 10.3390/nu16081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with inflammatory bowel disease (IBD) believe that diet plays a significant role in the pathogenesis of their disease and the exacerbation of their symptoms. They often adopt restrictive diets that can lead to malnutrition, anxiety, and stress. Recent studies have found a correlation between IBD and eating disorders, such as anorexia nervosa and ARFID (Avoidant Restrictive Food Intake Disorder). None of these studies report an association with orthorexia nervosa, which is an obsession with healthy and natural foods. The aim of this study was to assess the risk of orthorexia nervosa in patients with IBD. A total of 158 consecutive subjects were recruited, including 113 patients with IBD and 45 controls. The standardized Donini questionnaire ORTO-15 was administered to assess the risk of orthorexia, and clinical and demographic data were collected. The results showed that patients with IBD had a risk of developing orthorexia nervosa of 77%. This was significantly higher than the 47% observed in the control group. In the patients with IBD, the risk of orthorexia was associated with a lower BMI, at least in patients older than 30 years, and it was also associated with marital status in patients younger than 30. In conclusion, many patients with IBD are at increased risk of developing orthorexia nervosa, which may have a negative impact on their psychological wellbeing and social sphere, expose them to a high risk of nutritional deficiencies, and affect their overall quality of life. Further high-quality studies are needed to assess the clinical impact of orthorexia and its correlation with clinical features and classified eating disorders.
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Affiliation(s)
- Francesca Maria Di Giorgio
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Stefania Pia Modica
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Marica Saladino
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Stefano Muscarella
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Stefania Ciminnisi
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Piero Luigi Almasio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche, 2-90127 Palermo, Italy (S.P.M.); (S.M.)
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2
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Diet, Digestion, and the Dietitian: A Survey of Clinicians' Knowledge, Attitudes and Practices to Advance the Treatment of Gastrointestinal Disturbances in Individuals with Anorexia Nervosa. J Clin Med 2022; 11:jcm11195833. [PMID: 36233700 PMCID: PMC9573322 DOI: 10.3390/jcm11195833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Despite advances in treatment of anorexia nervosa (AN), current therapeutic approaches do not fully consider gastrointestinal disturbances (GID), often present in AN. Addressing GID, both symptoms and disorders, is likely to improve treatment adherence and outcomes in people with AN. GID are complex and are linked to a range of factors related to eating disorder symptomology and can be impacted by nutritional treatment. It is not known which dietetic practices are currently used to address GID in AN. Therefore, this survey aimed to explore the perceived knowledge, attitudes, and practices (KAP) of Australian dietitians treating AN and co-occurring GID. Seventy dietitians participated by completing an online survey. Knowledge scores were calculated based on correct responses to knowledge items (total: 12 points); and two groups were generated: higher knowledge (≥10 points, n = 31) and lower knowledge (≤9 points, n = 39). A greater proportion of dietitians with higher knowledge recognized the role of GID in pathogenesis of AN (p = 0.002) and its impact on quality of life (p = 0.013) and screened for GID (p ≤ 0.001), compared with those with lower knowledge. These results suggest that attitudes and practices toward patients presenting with AN and GID differ depending on level of knowledge. This may have important implications for treatment outcomes for individuals with AN and GID.
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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McGowan A, Harer KN. Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics. Gastroenterol Clin North Am 2021; 50:595-610. [PMID: 34304790 DOI: 10.1016/j.gtc.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome affects 10% to 15% of the population, and up to 90% of patients with irritable bowel syndrome exclude certain foods to improve their gastrointestinal symptoms. Although focused dietary restrictions are a normal, adaptive response, restrictions can spiral out of control and result in maladaptive restriction. Dietary therapies are rapidly becoming first-line treatment of irritable bowel syndrome, and gastroenterologists need to be aware of red flag symptoms of maladaptive eating patterns and the negative effects of prescribing restrictive diets. There is also growing awareness of the association between eating disorders and gastrointestinal symptoms, including irritable bowel syndrome symptoms.
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Affiliation(s)
- Andrea McGowan
- University of Michigan School of Public Health, c/o Kimberly Harer, 1500 East Medical Center Drive, 3912 TC SPC 5362, Ann Arbor, MI 48109, USA
| | - Kimberly N Harer
- University of Michigan, Division of Gastroenterology, Department of Internal Medicine, 1500 East Medical Center Drive, 3912 TC SPC 5362, Ann Arbor, MI 48109, USA.
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Hanel V, Schalla MA, Stengel A. Irritable bowel syndrome and functional dyspepsia in patients with eating disorders - a systematic review. EUROPEAN EATING DISORDERS REVIEW 2021; 29:692-719. [PMID: 34086385 DOI: 10.1002/erv.2847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The prevalence of eating disorders is rising worldwide. The low body weight in anorexia nervosa as well as the increase in body mass index due to binge eating disorder are contributing to a strikingly high morbidity and mortality. In a similar pattern, the prevalence and burden of the disease of functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome is increasing. As gastrointestinal complaints are commonly reported by patients with eating disorders, the question arose whether there is a relationship between eating disorders and functional gastrointestinal disorders. METHODS To address the need to better understand the interplay between eating disorders and functional gastrointestinal disorders as well as factors that might influence this connection, the data bases Medline, Web of Science and Embase were systematically searched. RESULTS After removal of duplicates the search yielded 388 studies which were screened manually. As a result, 36 publications were selected for inclusion in this systematic review. CONCLUSION The occurrence of functional gastrointestinal disorders like irritable bowel syndrome and functional dyspepsia in patients with eating disorders is considerably high and often associated with psychological, hormonal and functional alterations. In the future, further research addressing the underlying mechanisms accounting for this relationship is required.
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Affiliation(s)
- Vivien Hanel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martha A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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6
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Gibson D, Watters A, Mehler PS. The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?-A systematic review. Int J Eat Disord 2021; 54:1019-1054. [PMID: 34042203 DOI: 10.1002/eat.23553] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers-Danlos syndrome contribute toward disordered eating. METHODS Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to structure and complete the review. RESULTS A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. DISCUSSION Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers-Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.
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Affiliation(s)
- Dennis Gibson
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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Spillebout A, Dechelotte P, Ladner J, Tavolacci M. Mental health among university students with eating disorders and irritable bowel syndrome in France. Rev Epidemiol Sante Publique 2019; 67:295-301. [DOI: 10.1016/j.respe.2019.04.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
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Abstract
Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.
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Affiliation(s)
- Dennis Gibson
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Cassandra Workman
- Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA
| | - Philip S Mehler
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA.
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9
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Melchior C, Desprez C, Riachi G, Leroi AM, Déchelotte P, Achamrah N, Ducrotté P, Tavolacci MP, Gourcerol G. Anxiety and Depression Profile Is Associated With Eating Disorders in Patients With Irritable Bowel Syndrome. Front Psychiatry 2019; 10:928. [PMID: 31969841 PMCID: PMC6960100 DOI: 10.3389/fpsyt.2019.00928] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare the prevalence of anxiety and depression states and eating disorders (EDs) between patients with irritable bowel syndrome (IBS) and healthy volunteers without IBS. Methods: IBS patients according to Rome III criteria referred to our tertiary care center for therapeutic management and matched volunteers without IBS were prospectively included. EDs were screened by Sick, Control, One stone, Fat, Food-French version (SCOFF-F) questionnaire. IBS symptom severity (IBS symptom severity score), stool consistency (Bristol stool scale), anxiety and depression levels (Hospital Anxiety and Depression scale), and quality of life (validated Gastrointestinal Quality of Life Index) were assessed by validated self-questionnaires. Results: IBS (228) patients and healthy volunteers (228) were included. Mean age was 42.5 ± 13.9 years with mainly women (76.7%). Among IBS patients, 25.4% had positive SCOFF-F compared to 21.1% of volunteers. IBS patients more frequently had a lower body mass index (BMI) than volunteers (p < 0.0001). IBS patients with ED had poorer quality of life and more stressful life events (p = 0.02) than IBS patients without ED. The prevalence of anxiety and depression was significantly higher in IBS patients with ED than in volunteers without ED, respectively (19.0% vs 1.9%, p=0.00, and 60.3% vs 19.7%, p < 0.0001). Conclusions: The prevalence of ED assessed with positive SCOFF-F questionnaire was not significantly different between IBS patients and healthy volunteers. The combination of IBS and ED was associated with higher levels of anxiety or depression and poorer quality of life.
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Affiliation(s)
- Chloé Melchior
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Charlotte Desprez
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
| | - Ghassan Riachi
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anne-Marie Leroi
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France.,INSERM CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Pierre Déchelotte
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Najate Achamrah
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Philippe Ducrotté
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Marie-Pierre Tavolacci
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,INSERM CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Guillaume Gourcerol
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
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Differential Diagnoses of Food-Related Gastrointestinal Symptoms in Patients with Anorexia Nervosa and Bulimia Nervosa: A Review of Literature. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2018; 64:4-15. [PMID: 29498331 DOI: 10.13109/zptm.2018.64.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The present review investigates the prevalence and medical causes of food-related gastrointestinal symptoms in eating disorder (ED) patients and recommends a diagnostic algorithm based on the current literature. METHODS A literature search was conducted, which included publications from January 2000 until January 2017 Results: Over 90% of ED patients suffer from food-related symptoms. There is no evidence for a higher prevalence of immunological or structural gastrointestinal disorders in ED patients compared to the healthy population. Most food-related symptoms in ED patients are likely to be functional. CONCLUSIONS Diagnostic work-up of food-related symptoms in ED patients needs to be based on clinical history. Only if timing and quality of symptoms point towards a disorder independent from the ED is a comprehensive diagnostic work-up necessary.
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Zerwas S, Larsen JT, Petersen L, Thornton LM, Quaranta M, Koch SV, Pisetsky D, Mortensen PB, Bulik CM. Eating Disorders, Autoimmune, and Autoinflammatory Disease. Pediatrics 2017; 140:peds.2016-2089. [PMID: 29122972 PMCID: PMC5703777 DOI: 10.1542/peds.2016-2089] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Identifying factors associated with risk for eating disorders is important for clarifying etiology and for enhancing early detection of eating disorders in primary care. We hypothesized that autoimmune and autoinflammatory diseases would be associated with eating disorders in children and adolescents and that family history of these illnesses would be associated with eating disorders in probands. METHODS In this large, nationwide, population-based cohort study of all children and adolescents born in Denmark between 1989 and 2006 and managed until 2012, Danish medical registers captured all inpatient and outpatient diagnoses of eating disorders and autoimmune and autoinflammatory diseases. The study population included 930 977 individuals (48.7% girls). Cox proportional hazards regression models and logistic regression were applied to evaluate associations. RESULTS We found significantly higher hazards of eating disorders for children and adolescents with autoimmune or autoinflammatory diseases: 36% higher hazard for anorexia nervosa, 73% for bulimia nervosa, and 72% for an eating disorder not otherwise specified. The association was particularly strong in boys. Parental autoimmune or autoinflammatory disease history was associated with significantly increased odds for anorexia nervosa (odds ratio [OR] = 1.13, confidence interval [CI] = 1.01-1.25), bulimia nervosa (OR = 1.29; CI = 1.08-1.55) and for an eating disorder not otherwise specified (OR = 1.27; CI = 1.13-1.44). CONCLUSIONS Autoimmune and autoinflammatory diseases are associated with increased risk for eating disorders. Ultimately, understanding the role of immune system disturbance for the etiology and pathogenesis of eating disorders could point toward novel treatment targets.
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Affiliation(s)
| | - Janne Tidselbak Larsen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and
| | - Liselotte Petersen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and
| | | | - Michela Quaranta
- Department of Neuroscience, Azienda Ospedaliero-Universitaria San Giovanni Battista and University of Turin, Turin, Italy
| | - Susanne Vinkel Koch
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark;,Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen, Denmark
| | - David Pisetsky
- Medical Research Service, Durham Veterans Administration Medical Center and Division of Rheumatology and Immunology, Duke University, Durham, North Carolina; and
| | - Preben Bo Mortensen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Cynthia M. Bulik
- Departments of Psychiatry and,Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Umbilicus application with Chinese medicine for chronic diarrhea due to food intolerance in kids: a multicenter randomized trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2016. [DOI: 10.1007/s11726-016-0961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 2016; 21:353-364. [PMID: 26942768 PMCID: PMC5010619 DOI: 10.1007/s40519-016-0264-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHODS A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro. RESULTS Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively. CONCLUSIONS AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.
| | - Gábor Kovács
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary
| | - Dylan Supina
- Formerly of Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | | | | | - Zoltán Vokó
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.,Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1/a Pázmány Péter Street, 1117, Budapest, Hungary
| | - David V Sheehan
- University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA
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Wang X, Luscombe GM, Boyd C, Kellow J, Abraham S. Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using ROME III compared to ROME II criteria. World J Gastroenterol 2014; 20:16293-16299. [PMID: 25473186 PMCID: PMC4239520 DOI: 10.3748/wjg.v20.i43.16293] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the prevalence of Functional gastrointestinal disorders (FGIDs) using ROME III and ROME II and to describe predictors of FGIDs among eating disorder (ED) patients.
METHODS: Two similar cohorts of female ED inpatients, aged 17-50 years, with no organic gastrointestinal or systemic disorders, completed either the ROME III (n = 100) or the ROME II (n = 160) questionnaire on admission for ED treatment. The two ROME cohorts were compared on continuous demographic variables (e.g., age, BMI) using Student’s t-tests, and on categorical variables (e.g., ED diagnosis) using χ2-tests. The relationship between ED diagnostic subtypes and FGID categories was explored using χ2-tests. Age, BMI, and psychological and behavioural predictors of the common (prevalence greater than 20%) ROME III FGIDs were tested using logistic regression analyses.
RESULTS: The criteria for at least one FGID were fulfilled by 83% of the ROME III cohort, and 94% of the ROME II cohort. There were no significant differences in age, BMI, lowest ever BMI, ED diagnostic subtypes or ED-related quality of life (QOL) scores between ROME II and ROME III cohorts. The most prevalent FGIDs using ROME III were postprandial distress syndrome (PDS) (45%) and irritable bowel syndrome (IBS) (41%), followed by unspecified functional bowel disorders (U-FBD) (24%), and functional heartburn (FH) (22%). There was a 29% or 46% increase (depending on presence or absence of cyclic vomiting) in functional gastroduodenal disorders because of the introduction of PDS in ROME III compared to ROME II. There was a 35% decrease in functional bowel disorders (FBD) in Rome III (excluding U-FBD) compared to ROME II. The most significant predictor of PDS was starvation (P = 0.008). The predictor of FH (P = 0.021) and U-FBD (P = 0.007) was somatisation, and of IBS laxative use (P = 0.025). Age and BMI were not significant predictors. The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROME III added precision to many FGIDs.
CONCLUSION: ROME III confers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting. Psychological factors appear to be more influential in ROME II than ROME III.
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Salvioli B, Pellicciari A, Iero L, Di Pietro E, Moscano F, Gualandi S, Stanghellini V, De Giorgio R, Ruggeri E, Franzoni E. Audit of digestive complaints and psychopathological traits in patients with eating disorders: a prospective study. Dig Liver Dis 2013; 45:639-44. [PMID: 23582347 DOI: 10.1016/j.dld.2013.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/14/2013] [Accepted: 02/27/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophago-gastrointestinal symptoms are frequently reported by patients with eating disorders. Scanty data exist on the relationship between psychopathological traits and digestive complaints. AIMS To prospectively analyze (i) prevalence of digestive symptoms; (ii) psychopathological traits; (iii) relationship between symptom scores and psychopathological profiles. METHODS Psychopathological and digestive symptom questionnaires were completed at baseline, at discharge, at 1 and 6 months' follow-up in 48 consecutive patients (85.4% female, median age, 15 years) hospitalized for eating disorders. RESULTS The most frequently reported symptoms were postprandial fullness (96%) and abdominal distention (90%). Pooled esophageal (4; IQR 0-14) and gastrointestinal (34; IQR 19-53) symptoms significantly decreased at 6 months' follow-up (1; IQR 0-3 and 10; IQR 4-34; p<0.0001 and p<0.005, respectively). Pooled gastrointestinal symptoms significantly correlated with hypochondriasis (r=0.42, p<0.01). Both esophageal and gastrointestinal symptoms improved in patients with normal values of hypochondriasis and hysteria scales (p<0.05 and p<0.005, respectively) compared to those with pathological traits. CONCLUSIONS Digestive symptoms are frequently reported by patients with eating disorders with their expression and outcome being influenced by psychopathological profiles. Hypochondriasis and hysteria traits are predictive factors for symptomatic improvement.
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16
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Abbate-Daga G, Delsedime N, Nicotra B, Giovannone C, Marzola E, Amianto F, Fassino S. Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry 2013; 13:14. [PMID: 23302180 PMCID: PMC3556145 DOI: 10.1186/1471-244x-13-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 01/03/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients. METHODS 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory-2, and Temperament and Character Inventory. Data were submitted to cluster analysis. RESULTS Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome. CONCLUSIONS These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.
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Affiliation(s)
- Giovanni Abbate-Daga
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy.
| | - Nadia Delsedime
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Barbara Nicotra
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Cristina Giovannone
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Enrica Marzola
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, Section of Psychiatry, Eating Disorders Centre, University of Turin, Turin, Italy
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17
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Guo H, Jiang T, Wang J, Chang Y, Guo H, Zhang W. The value of eliminating foods according to food-specific immunoglobulin G antibodies in irritable bowel syndrome with diarrhoea. J Int Med Res 2012; 40:204-10. [PMID: 22429360 DOI: 10.1177/147323001204000121] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study investigated the role of food intolerance in irritable bowel syndrome with diarrhoea (D-IBS). METHODS Specific immunoglobulin G (IgG) antibodies against 14 common food antigens in the serum were measured in 77 patients with D-IBS and 26 healthy controls. Food-specific IgG antibodies were identified in 39 (50.65%) patients with D-IBS patients compared with four (15.38%) controls. For 12 weeks following the serological testing, 35 patients with D-IBS and food intolerance consumed diets that excluded the identified food. Changes in the main symptoms of D-IBS were evaluated before treatment and regularly during treatment in these patients. RESULTS After 4 weeks' dietary therapy, most symptoms of D-IBS had improved. By 12 weeks, all symptom scores had decreased significantly compared with the baseline scores. CONCLUSIONS The 12-week specific-food exclusion diets resulted in significant improvements in abdominal pain (bloating level and frequency), diarrhoea frequency, abdominal distension, stool shape, general feelings of distress and total symptom score compared with baseline in patients with D-IBS.
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Affiliation(s)
- Hong Guo
- Department of Gastroenterology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
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18
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Abraham S, Luscombe GM, Kellow JE. Pelvic floor dysfunction predicts abdominal bloating and distension in eating disorder patients. Scand J Gastroenterol 2012; 47:625-31. [PMID: 22486766 DOI: 10.3109/00365521.2012.661762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Little is known about the symptoms of abdominal bloating and distension in women with eating disorders (EDs). This study aimed to explore the prevalence and predictors of these symptoms in patients with EDs, by examining correlations with functional gastrointestinal disorders (FGIDs) including pelvic floor symptoms and other clinical features. MATERIAL AND METHODS 184 ED inpatients, 16-55 years, completed on admission to hospital the ROME II symptom questionnaire, additional questions about abdominal bloating and distension, and psychological questionnaires. Prediction of abdominal bloating and distension was modeled using logistic regression analyses with individual FGIDs, psychological variables, ED type, and clinical features as the potential predictors. RESULTS Bloating (78%) was more common than distension (58%) in each ED type. In the final multivariate models, after controlling for BMI, the number of Rome II symptoms of pelvic floor dyssynergia (i.e., having to strain to pass a stool, feeling unable to empty the rectum, and having difficulty relaxing to evacuate the stool) was a significant predictor of both abdominal distension (p < 0.001) and bloating (p < 0.005). The presence of irritable bowel syndrome (IBS, 46%) was a significant predictor of bloating (p < 0.001) but not distension. CONCLUSIONS Symptoms of pelvic floor dysfunction, but not IBS, appear to be especially important in the genesis of abdominal distension in patients with ED.
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Affiliation(s)
- Suzanne Abraham
- Department of Obstetrics and Gynaecology, Northside Clinic, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
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