Bilateral facial swelling in bulimia

Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis

BACKGROUND

Eating disorders (ED) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are often accompanied by a variety of psychological and physical comorbidities. Gastrointestinal (GI) symptoms are a classical feature in most patients with ED. The heterogeneity of studies on this topic is high, making it difficult to have a clear overview. The aim of this systematic review is therefore to provide an overview of subjectively and objectively measured differences and changes in the GI tract in patients with EDs, along with the occurrence of GI complications.

METHODS

A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar to find all relevant studies examining GI problems in AN, BN, and BED. Quantitative analyses were performed for objective GI physiology measures where applicable.

RESULTS

The review differentiated between ED types and also between studies that report GI outcomes of ED in (i) human studies with an ED diagnosis excluding case reports that provide an overview of GI problems in ED and (ii) case reports with an ED diagnosis describing rare GI complications in ED. GI symptoms and impaired gastric transit times were frequent features of EDs with specific differences found for the ED types. During the time course of treatment, GI symptoms changed and/or improved but not completely. GI complications extended the range of GI problems observed, including a variety of serious complications such as gastric dilatation.

CONCLUSIONS

Problems of the GI tract are frequent in patients with ED and it is likely that they complicate therapy, especially in patients with AN.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42019100585.

Recognition and management of eating disorders in the dental office

Extensive damage to the teeth may result from self-induced vomiting. Recognition of the oral signs of eating disorders is a responsibility of dental care providers. Young women with BN and AN may seek dental care before seeking medical treatment because they are concerned about their appearance. Early identification of oral changes by the dental practitioner and referral to medical and psychiatric therapists can reduce the risk of further physical damage to the body or greater loss of tooth surface enamel. Home care instructions will be followed when the reasons for timing of toothbrushing, rinsing after vomiting, and use of fluoride are explained. Careful selection of beverages and snacks will help reduce the risk of further erosion and dental caries. Comprehensive dental procedures should not be undertaken until significant improvement in vomiting behavior or complete recovery has occurred.

Revisiting a controversial surgical technique in the treatment of bulimic parotid hypertrophy

Bulimia nervosa is a recognized cause of bilateral parotid gland enlargement that may not be appreciated by most otolaryngologists. Classically the parotid enlargement is transient but may be permanent and spectacular. Our review of the published literature revealed only 2 previous cases that have been considered for superficial parotidectomy, along with much debate as to the efficacy of such treatments. Neither case reported any postoperative complications. We present a bulimic patient who developed bilateral postoperative fistulae after surgery for marked, permanent enlargement of her parotids. Both fistulas closed spontaneously. However, a year later she has relapsed into bulimic behavior and developed further parotid gland hypertrophy. Because of this complication, we believe surgery has no role to play in the overall treatment of these severe cases unless the patients show a prolonged cessation of their bulimic behavior.

Eating disorders and the dentist

Dentists are likely to encounter patients who have eating disorders. The paper explains the various types and considers both the risk factors, and the psychological and medical complications. The effect on oral health and the principles of dental management are outlined. Dentists have an important part to play in the overall care of these patients.

Anorexia and bulimia nervosa (the eating disorders): conditions of interest to the dental practitioner

OBJECTIVES

This paper aims to give the dental practitioner an insight into the impact of the eating disorders on sufferers.

METHODS

A review of the psychiatric literature on the diagnosis, aetiology and treatment of these conditions is given.

CONCLUSIONS

The dental practitioner is in an ideal position to identify the warning signs of these conditions before they have attracted medical attention.

Enlargement of salivary glands in bulimia

We report a unusual case of bulimia nervosa with bilateral swelling of parotid and submandibular glands as the only symptom of the underlying behavioural disorder. Histologically, sialadenosis was diagnosed in a parotid biopsy. The parotomegaly in bulimia may be a diagnostic primer as these patients often deny their eating disorder. B-scan ultrasonography is an important diagnostic tool to assess the nature of the parotid enlargement. Hyperamylasaemia occurs commonly in bulimic patients and may help to confirm the diagnosis. All patients with suspected bulimia should have a thorough medical history and physical examination to rule out other aetiologies of asymptomatic parotid swelling. As the enlargement is usually transient surgical intervention is only rarely required.