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Bozzola E, Irrera M, Cirillo F, Zanna V, Petrelli I, Diamanti A, Scire Y, Park J, Marchesi A, Marchili MR, Villani A. Superior Mesenteric Artery Syndrome in Anorexia Nervosa: A Case Report and a Systematic Revision of the Literature. Nutrients 2024; 16:541. [PMID: 38398865 PMCID: PMC10893019 DOI: 10.3390/nu16040541] [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: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the duodenum, which may occur in the case of fast weight loss. Currently, the relationship between superior mesenteric artery syndrome and anorexia nervosa is still unclear. The aim of this study is to identify the precocious clinical signs and symptoms of SMAS in patients affected by anorexia nervosa so as not to delay the diagnosis. METHODS We present the clinical case of a young female patient with anorexia nervosa complicated by SMAS. We performed a literature review of SMAS in children affected by anorexia nervosa between 1962 and 2023, according to the PRISMA Extension Guide for Scoping Reviews. RESULTS Reviewing the literature, 11 clinical cases were described for the pediatric age. The median age at diagnosis was 17 years (ranging from 13 to 18 years). The diagnosis of SMAS may be challenging as symptoms overlap those of anorexia, but it should be kept in mind mostly in cases of post-prandial abdominal pain, anxiety or depression, nausea, vomiting, and weight loss. CONCLUSION Even specific clinical symptoms may act as flag tags to drive attention to this rare but potentially fatal condition.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Mariangela Irrera
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Flavia Cirillo
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Italo Petrelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, 00100 Rome, Italy
| | - Ylenia Scire
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
| | - Jibin Park
- Medicine and Surgery School, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | | | | | - Alberto Villani
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, 00100 Rome, Italy
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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: 20] [Impact Index Per Article: 6.7] [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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Deshpande SH, Thomas J, Chiranjeev R, Pandya JS. Superior mesenteric artery syndrome in a patient with celiacomesenteric trunk. BMJ Case Rep 2021; 14:14/2/e237132. [PMID: 33622741 PMCID: PMC7907866 DOI: 10.1136/bcr-2020-237132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.
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Affiliation(s)
| | - Jenny Thomas
- General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Roshan Chiranjeev
- General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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Hetterich L, Mack I, Giel KE, Zipfel S, Stengel A. An update on gastrointestinal disturbances in eating disorders. Mol Cell Endocrinol 2019; 497:110318. [PMID: 30359760 DOI: 10.1016/j.mce.2018.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/27/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023]
Abstract
Eating disorders, namely anorexia nervosa, bulimia nervosa and binge eating disorder are frequent diseases and often complicated by comorbidities, e.g. psychiatric or cardiovascular comorbidities. It is to note that also gastrointestinal symptoms/complications are frequently observed in patients with eating disorders. These diseases will be presented in the current review along with - where known - possible underlying mechanisms. Lastly, gaps in knowledge will be highlighted.
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Affiliation(s)
- Larissa Hetterich
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Isa Mack
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany; Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
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Albano MN, Costa Almeida C, Louro JM, Martinez G. Increase body weight to treat superior mesenteric artery syndrome. BMJ Case Rep 2017; 2017:bcr-2017-219378. [PMID: 28576908 DOI: 10.1136/bcr-2017-219378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta and SMA. CASE PRESENTATION A 19-year-old woman with anorexia nervosa with upper gastrointestinal obstruction symptoms resorted to the emergency department. A diagnosis of SMA syndrome was made. Symptoms were solved with conservative treatment aimed at increase body weight. DISCUSSION SMA syndrome is most commonly associated with debilitating illnesses. Patients present with acute or insidious upper gastrointestinal obstruction symptoms. Aortomesenteric artery angle of ≤25° is the most sensitive measure of diagnosis. Advances in both enteral and parenteral nutrition led to a shift towards conservative treatment. CONCLUSIONS Low threshold of suspicion is important to make a timely diagnosis and treatment. A conservative treatment aimed at increasing body weight is the first-line approach, leaving surgical intervention for failure cases.
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Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol 2015; 8:255-63. [PMID: 26499370 DOI: 10.1007/s12328-015-0611-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.
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Lee TH, Lee JS, Jo Y, Park KS, Cheon JH, Kim YS, Jang JY, Kang YW. Superior mesenteric artery syndrome: where do we stand today? J Gastrointest Surg 2012; 16:2203-11. [PMID: 23076975 DOI: 10.1007/s11605-012-2049-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/04/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most data on large studies of superior mesenteric artery syndrome (SMAS) were published over 30 years ago. New studies are needed so that current medical progress can influence SMAS diagnosis and improve therapeutic outcomes. METHODS This study was conducted to report the clinical features and outcomes of SMAS. From January 2000 to December 2009, 80 cases (53 females, median age 28 years) of SMAS were collected retrospectively from seven university hospitals in South Korea. RESULTS The median body mass index at diagnosis was 17.4 kg/m(2), with a range of 10-22.1. Forty (50 %) of the 80 SMAS patients had co-morbid conditions including mental and behavioral disorders, infectious disorders, and disorders of the nervous system (21.3, 12.5, and 11.3 %, respectively). Computerized tomography was most commonly (93.8 %) used to diagnose SMAS. The overall medical management success and recurrence rates were 71.3 and 15.8 %, respectively. Surgical management had a high 92.9 % (13/14) success rate. The most common surgical procedure for SMAS was laparoscopic duodenojejunostomy. CONCLUSIONS This is the largest case series to document the clinical features and changes in diagnostic modalities, medical and surgical managements, and their outcomes in SMAS patients. Laparoscopic duodenojejunostomy is the preferred surgical procedure when medical management of the disease fails.
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Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul, South Korea
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Park YS, Kim JS, Hwang JY. Superior Mesenteric Artery Syndrome Leading to Acute Gastric Dilatation in a Woman with Bulimia. HONG KONG J EMERG ME 2011. [DOI: 10.1177/102490791101800207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Superior mesenteric artery (SMA) syndrome is a rare clinical disease defined as compression of the third part of the duodenum between the aorta and the SMA. Severe complications of SMA syndrome include acute gastric dilatation which is uncommon but potentially fatal and requires immediate intervention. This report describes a 29-year-old woman with SMA syndrome complicated by acute gastric dilatation. It was diagnosed by computerized tomography. The patient had a history of treatment of bulimia nervosa but defaulted 3 months ago. She presented with severe abdominal distension and extreme abdominal pain due to massive gastric dilatation after an eating binge. Gastric decompression was successful with a modified gastric lavage tube with additional large holes at the tip.
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Affiliation(s)
- YS Park
- Sungkyunkwan University School of Medicine, Department of Family Medicine, Samsung Medical Center, Seoul, Korea
| | | | - JY Hwang
- Kangnam Sacred Heart Hospital, Department of Radiology, Hallym University School of Medicine, Seoul, Korea
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Verhoef PA, Rampal A. Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: a case report. J Med Case Rep 2009; 3:127. [PMID: 19946542 PMCID: PMC2783065 DOI: 10.1186/1752-1947-3-127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 11/16/2009] [Indexed: 12/15/2022] Open
Abstract
Introduction Nausea and vomiting in an adolescent, though common presenting symptoms, often pose a diagnostic and therapeutic challenge to the physician. When the diagnosis involves both medical and psychiatric components, management can be complex, especially in the current healthcare system in the United States. To the best of our knowledge, there have been no previous publications detailing successful management of a patient with anorexia nervosa and superior mesenteric artery syndrome. Case presentation We report the case of a 16-year-old Caucasian girl who presented to our emergency department with nausea, abdominal pain, diminished appetite and vomiting. Her history and examination were notable for a 15 kg weight loss and diffuse abdominal tenderness. A barium swallow X-ray with small bowel follow-through and computed tomography scan demonstrated remarkable duodenal narrowing between the superior mesenteric artery and the aorta, consistent with superior mesenteric artery syndrome. Initial management focused on relieving the obstruction and supporting the nutritional needs of the patient. Further history confirmed a diagnosis of anorexia nervosa, requiring intensive psychiatric and medical management, and necessitating a multifaceted approach to patient care involving social work, multiple primary care physicians and subspecialists, insurance company representatives, and the patient's immediate family. Conclusion This case illustrates important points regarding the pathogenesis of superior mesenteric artery syndrome in the setting of anorexia, and it highlights the complexities that arise when managing an adolescent with both medical and psychiatric needs, as well as outlining a viable solution. While superior mesenteric artery syndrome is an uncommon cause of small bowel obstruction, the general pediatrician and child psychiatrist should be aware of this complication of anorexia nervosa.
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Affiliation(s)
- Philip A Verhoef
- Department of Internal Medicine, University of California, Los Angeles, Le Conte Ave, Los Angeles, CA, USA
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Okugawa Y, Inoue M, Uchida K, Kawamoto A, Koike Y, Yasuda H, Otake K, Miki C, Kusunoki M. Superior mesenteric artery syndrome in an infant: case report and literature review. J Pediatr Surg 2007; 42:E5-8. [PMID: 17923187 DOI: 10.1016/j.jpedsurg.2007.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Superior mesenteric artery syndrome (SMAS) is an obstruction at the third portion of the duodenum by compression between the superior mesenteric artery and the aorta. In infancy, SMAS is extremely rare; and for its diagnosis, other duodenal obstructive diseases including congenital duodenal stenosis and intestinal malrotation must be ruled out. We present the case of a 7-month-old girl with frequent bilious vomiting after the resolution of acute gastroenteritis. Superior mesenteric artery syndrome was finally diagnosed at laparotomy, and duodenojejunostomy was performed. Vomiting disappeared postoperatively, and she gained weight. Although SMAS is an extremely rare syndrome in infants, it should be considered as a possible cause of incomplete duodenal obstruction.
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Affiliation(s)
- Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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Moreno MA, Smith MS. Anorexia in a 14-year-old girl: why won't she eat? J Adolesc Health 2006; 39:936-8. [PMID: 17116532 DOI: 10.1016/j.jadohealth.2006.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 05/23/2006] [Accepted: 05/25/2006] [Indexed: 10/24/2022]
Abstract
This is a clinical presentation of a 14-year-old female who had weight loss and vomiting following spinal fusion surgery. Her case was complicated by social and behavioral issues. After an initial diagnosis of atypical eating disorder, an upper gastrointestinal study revealed superior mesenteric artery syndrome. Her course continued to be complicated until consistent follow-up with a nutritionist was established.
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Affiliation(s)
- Megan A Moreno
- Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington 98105, USA.
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Jordaan GP, Muller A, Greeff M, Stein DJ. Eating disorder and superior mesenteric artery syndrome. J Am Acad Child Adolesc Psychiatry 2000; 39:1211. [PMID: 11026172 DOI: 10.1097/00004583-200010000-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stheneur C, Rey C, Pariente D, Alvin P. [Acute gastric dilatation with superior mesenteric artery syndrome in a young girl with anorexia nervosa]. Arch Pediatr 1995; 2:973-6. [PMID: 7496475 DOI: 10.1016/0929-693x(96)89893-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute gastric dilatation is a rare complication of anorexia nervosa which may be fatal in case of gastric perforation. Superior mesenteric artery syndrome may be associated with gastric dilatation. CASE REPORT A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of abdominal pain related to a bulimic episode a few days before, followed by nausea and vomiting. Distended abdomen and tachycardia suggested acute small-bowel obstruction. A diagnosis of acute gastric dilatation with superior mesenteric artery syndrome was suspected on X-ray examination and confirmed by esophagogastrography after gastric evacuation. The patient improved rapidly under total parenteral nutrition. Upper gastrointestinal study repeated 10 days later showed normal stomach. CONCLUSIONS Small-bowel obstruction in anorexia nervosa first evokes acute gastric dilatation, and a perforation has to be ruled out by esophagogastrography. Association with superior mesenteric artery syndrome is possible; it does not necessarily lead to surgery.
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Affiliation(s)
- C Stheneur
- Service de médecine pour adolescents, hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Buchman A. "Superior mesenteric artery syndrome" as a complication of enteral feeding. Nutr Clin Pract 1995; 10:86. [PMID: 7731429 DOI: 10.1177/011542659501000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Buchman AL, Ament ME, Weiner M, Kodner A, Mayer EA. Reversal of megaduodenum and duodenal dysmotility associated with improvement in nutritional status in primary anorexia nervosa. Dig Dis Sci 1994; 39:433-40. [PMID: 8313830 DOI: 10.1007/bf02090220] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Anorexia nervosa is considered one type of eating disorder that may result in severe malnutrition. Patients with this disorder commonly complain of postprandial nausea, abdominal pain, and distension. We describe the radiologic and motility abnormalities associated with anorexia nervosa in a 21-year-old female. Barium gastrointestinal series demonstrated marked dilation of the duodenum, with prolongation of intestinal transit. A 4-hr fasting gastroduodenal motility study showed no propagating migrating motor complexes (MMC). Prolonged, but nonpropagating, bursts of high-amplitude phasic and tonic contractions were seen in the duodenum. In contrast, antral contractions were of low amplitude and esophageal motor function was normal. Metoclopramide and edrophonium caused an increase in gastroduodenal motor activity, but increased contractions were not associated with symptoms. Following a renutrition program that raised the patient's weight from 64 to 80% of her ideal body weight, the radiographic abnormalities and gastrointestinal dysmotility resolved completely. These observations suggest that anorexia-associated gastrointestinal motor dysfunctions are a consequence, not the cause of the generalized protein-calorie malnutrition associated with anorexia nervosa. The facts that motility in different parts of the gut is affected to different degrees and that gastric and duodenal muscle responds normally to exogenous stimulation argue against a generalized myogenic dysfunction and, rather, point to a reversible dysfunction of neural regulation.
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Affiliation(s)
- A L Buchman
- Division of Pediatric Gastroenterology and Nutrition, UCLA Medical Center 90024
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Abstract
An 18-year-old woman presented with SMAS: an additional diagnosis of anorexia nervosa was later made. Both conditions should be considered when an adolescent presents with weight loss and vomiting.
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Kornmehl P, Weizman Z, Liss Z, Bar-Ziv J, Joseph A. Superior mesenteric artery syndrome presenting as an anorexia nervosa-like illness. JOURNAL OF ADOLESCENT HEALTH CARE : OFFICIAL PUBLICATION OF THE SOCIETY FOR ADOLESCENT MEDICINE 1988; 9:340-3. [PMID: 3417512 DOI: 10.1016/0197-0070(88)90263-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Anorexia nervosa is often overdiagnosed in adolescent females with anorexia and extreme weight loss. In some cases, an anorexia nervosa-like illness is due to a treatable organic disorder. We describe a 16-year-old female with anorexia, vomiting, extreme weight loss, and amenorrhea who was referred as an anorexia nervosa case and was subsequently found to have superior mesenteric artery syndrome that was causing a duodenal obstruction. Conservative treatment with oral hypercaloric liquid feeding resulted in optimal weight gain and complete recovery. This syndrome should be considered in adolescents with an anorexia nervosa-like illness associated with vomiting and postprandial epigastric discomfort.
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Affiliation(s)
- P Kornmehl
- Department of Adolescent Medicine, Soroka Medical Center, Beer-Sheva, Israel
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Abstract
A case of anorexia nervosa associated with gastric rugal hyperplasia in a 36-year-old male is reported and some speculations are made about the relationship between these two conditions.
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Affiliation(s)
- A D Cockett
- Instite of Family Psychiatry, Ipswich, Suffolk
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Pumariega AJ, Pursell J, Spock A, Jones JD. Eating disorders in adolescents with cystic fibrosis. JOURNAL OF THE AMERICAN ACADEMY OF CHILD PSYCHIATRY 1986; 25:269-75. [PMID: 3700917 DOI: 10.1016/s0002-7138(09)60237-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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