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Joel MA, Cooper M, Peebles R, Albenberg L, Timko CA. Clinical characterization of Co-morbid autoimmune disease and eating disorders: a retrospective chart review. Eat Disord 2024; 32:353-368. [PMID: 38270383 DOI: 10.1080/10640266.2024.2306437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Research suggests a link between autoimmune illnesses (AI) and eating disorders (ED). We retrospectively reviewed charts of adolescent patients presenting for eating disorder treatment. We compared the presentation and treatment course for those with an ED and comorbid AI [with (GI-AI, N = 59) or without (non-GI, N = 21) gastrointestinal inflammation] with matched ED-only cases. The sample was overwhelmingly female, with an average age of 15.40. Weight gain trajectories differed across groups, with similar rates of weight gain between controls and non GI-AI cases and with a lower rate of weight gain for individuals with comorbid GI-AI. Over half (56%) of patients reported an AI diagnosis prior to ED; 38% reported an AI diagnosis following ED, and 6% reported ED and AI simultaneous diagnosis. On presentation, ED-only controls had higher rates of comorbid anxiety than cases in either AI group, while those with non-GI AI were more likely to report depression. Mean total GI symptoms, % goal weight at presentation, vital sign instability, and markers of refeeding syndrome did not differ across groups. Health care professionals treating patients with either condition should have a low threshold for asking additional questions to identify the presence of the other condition.
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Affiliation(s)
- Marisa A Joel
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebecka Peebles
- CHOP's medical school uses divisions, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsey Albenberg
- CHOP's medical school uses divisions, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Almeida MN, Atkins M, Garcia-Fischer I, Weeks IE, Silvernale CJ, Samad A, Rao F, Burton-Murray H, Staller K. Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010-2020. Neurogastroenterol Motil 2024; 36:e14782. [PMID: 38488182 PMCID: PMC11147706 DOI: 10.1111/nmo.14782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/10/2024] [Accepted: 03/04/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) disorders are common in patients with eating disorders. However, the temporal relationship between GI and eating disorder symptoms has not been explored. We aimed to evaluate GI disorders among patients with eating disorders, their relative timing, and the relationship between GI diagnoses and eating disorder remission. METHODS We conducted a retrospective analysis of patients with an eating disorder diagnosis who had a GI encounter from 2010 to 2020. GI diagnoses and timing of eating disorder onset were abstracted from chart review. Coders applied DSM-5 criteria for eating disorders at the time of GI consult to determine eating disorder remission status. RESULTS Of 344 patients with an eating disorder diagnosis and GI consult, the majority (255/344, 74.2%) were diagnosed with an eating disorder prior to GI consult (preexisting eating disorder). GI diagnoses categorized as functional/motility disorders were most common among the cohort (57.3%), particularly in those with preexisting eating disorders (62.5%). 113 (44.3%) patients with preexisting eating disorders were not in remission at GI consult, which was associated with being underweight (OR 0.13, 95% CI 0.04-0.46, p < 0.001) and increasing number of GI diagnoses (OR 0.47 per diagnosis, 95% CI 0.26-0.85, p = 0.01). CONCLUSIONS Eating disorder symptoms precede GI consult for most patients, particularly in functional/motility disorders. As almost half of eating disorder patients are not in remission at GI consult. GI providers have an important role in screening for eating disorders. Further prospective research is needed to understand the complex relationship between eating disorders and GI symptoms.
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Affiliation(s)
- Mariana N Almeida
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Micaela Atkins
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isabelle Garcia-Fischer
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Imani E Weeks
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Casey J Silvernale
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ahmad Samad
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatima Rao
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helen Burton-Murray
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Staller
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Pomenti S, Katzka DA. Current state of rumination syndrome. Dis Esophagus 2024:doae041. [PMID: 38741462 DOI: 10.1093/dote/doae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
Rumination syndrome (RS) is an underdiagnosed behavioral disorder of recurrent regurgitation. Regurgitation occurs in RS due to increased gastric pressure achieved by subconscious contraction of the abdominal musculature wall, reversing the pressure gradient between the esophagus and the stomach. RS is mainly diagnosed clinically by the Rome Criteria with symptoms of regurgitation without retching of recently ingested food into the mouth and subsequent spitting or re-mastication. When the diagnosis is unable to be made clinically, supportive testing including fed impedance manometry can be considered. RS occurs worldwide, affecting patients of all ages, races, and genders with a prevalence of 3.1-5.8%. There is significant overlap with RS and disorders of a gut-brain interaction and upright gastroesophageal reflux driven by aerophagia and supragastric belching. There is also an association with mood disorder, fibromyalgia, and eating disorders. RS may be misdiagnosed as a variety of other syndromes including gastroesophageal reflux disease, gastroparesis, achalasia, and bulimia nervosa. Once RS is diagnosed, the mainstay of treatment is diaphragmatic breathing to lower the intragastric pressure and increase the lower esophageal pressure. Diaphragmatic breathing can be supported with biofeedback and cognitive behavioral therapy as well as medication options for more refractory cases. Response to therapy overtime and changes in symptoms overtime can now be tracked with a validated questionnaire.
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Affiliation(s)
- Sydney Pomenti
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - David A Katzka
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
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4
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Quiroga-Castañeda PP, Berrios-Villegas I, Valladares-Garrido D, Vera-Ponce VJ, Zila-Velasque JP, Pereira-Victorio CJ, Valladares-Garrido MJ. Irritable Bowel Syndrome in medical students at a Peruvian university: a cross-sectional study. Front Med (Lausanne) 2024; 11:1341809. [PMID: 38646550 PMCID: PMC11026545 DOI: 10.3389/fmed.2024.1341809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Irritable Bowel Syndrome has emerged as a significant public health challenge, particularly relevant in medical students due to the high demands of their studies, academic stress, and susceptibility to eating disorders. Nevertheless, conclusive evidence regarding the factors associated with Irritable Bowel Syndrome in the Latin American student population remains limited. The objective of this study was to determine the prevalence and factors associated with Irritable Bowel Syndrome in Human Medicine students at a university in northern Peru. Methods A cross-sectional analytical study conducted in Lambayeque, northern Peru. With 403 Human Medicine students (66.5% female, 33.5% male). A simple random probabilistic sampling type was used, based on a list of students enrolled. A multivariate analysis was conducted to determine the factors associated using simple and multiple regression models. Generalized Linear Models were applied, using the Poisson distribution family, robust variance, and the academic year as a cluster. Results The prevalence of Irritable Bowel Syndrome was 16.9% (95% CI: 13.37-20.86). The median age was 21 years, with 66.5% being female. In the multiple regression analysis, Irritable Bowel Syndrome was associated with a higher prevalence of depression (PR: 3.63; 95% CI: 1.26-10.49) and eating disorders (PR: 1.57; 95% CI: 1.01-2.43). For each additional year of age, the prevalence of Irritable Bowel Syndrome decreased by 9% (PR: 0.91; 95% CI: 0.83-0.99). Conclusion This study reveals that approximately two out of every 10 students exhibit symptoms related to IBS, underscoring its significance in the Human Medicine student population. Furthermore, depression and eating disorders were identified as significant factors associated with IBS in students. Consequently, it is essential to focus efforts on early identification and the implementation of preventive measures to mitigate the development of this pathology, given its substantial prevalence in this context of Human Medicine students.
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Affiliation(s)
| | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Trujillo, Peru
- Oficina de Salud Ocupacional, Hospital Santa Rosa, Piura, Peru
| | - Víctor J. Vera-Ponce
- Instituto de Investigación de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
- Universidad Tecnológica del Perú, Lima, Peru
| | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en La Altitud e Investigación (REDLAMAI), Pasco, Peru
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5
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Landini L, Dadson P, Gallo F, Honka MJ, Cena H. Microbiota in anorexia nervosa: potential for treatment. Nutr Res Rev 2023; 36:372-391. [PMID: 35875979 DOI: 10.1017/s0954422422000130] [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] [Indexed: 11/07/2022]
Abstract
Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected, coupled with an intense fear of gaining weight. Treatment of AN is currently based on psychological and refeeding approaches, but their efficacy remains limited since 40% of patients after 10 years of medical care still present symptoms of AN. The intestine hosts a large community of microorganisms, called the "microbiota", which live in symbiosis with the human host. The gut microbiota of a healthy human is dominated by bacteria from two phyla: Firmicutes and, majorly, Bacteroidetes. However, the proportion in their representation differs on an individual basis and depends on many external factors including medical treatment, geographical location and hereditary, immunological and lifestyle factors. Drastic changes in dietary intake may profoundly impact the composition of the gut microbiota, and the resulting dysbiosis may play a part in the onset and/or maintenance of comorbidities associated with AN, such as gastrointestinal disorders, anxiety and depression, as well as appetite dysregulation. Furthermore, studies have reported the presence of atypical intestinal microbial composition in patients with AN compared with healthy normal-weight controls. This review addresses the current knowledge about the role of the gut microbiota in the pathogenesis and treatment of AN. The review also focuses on the bidirectional interaction between the gastrointestinal tract and the central nervous system (microbiota-gut-brain axis), considering the potential use of the gut microbiota manipulation in the prevention and treatment of AN.
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Affiliation(s)
- Linda Landini
- S.S.D. Dietetics and Clinical Nutrition ASL 4 Chiavarese Liguria-Sestri Levante Hospital, Sestri Levante, Italy
| | - Prince Dadson
- Turku PET Centre, University of Turku, Turku, Finland
| | - Fabrizio Gallo
- S.S.D. Dietetics and Clinical Nutrition ASL 4 Chiavarese Liguria-Sestri Levante Hospital, Sestri Levante, Italy
| | | | - Hellas Cena
- Dietetics and Clinical Nutrition Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
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6
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Beckmann EA, Aarnio-Peterson CM, Jastrowski Mano KE. Advancing the Assessment and Treatment of Comorbid Pediatric Chronic Functional Abdominal Pain (CFAP) and Restrictive Eating Disorders. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1539. [PMID: 37761500 PMCID: PMC10527586 DOI: 10.3390/children10091539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
The aim of this review is to heighten awareness of the association between chronic functional abdominal pain (CFAP) and restrictive eating disorders (ED) in adolescents. We describe current diagnostic practices and propose future research efforts to improve the assessment and treatment of comorbid CFAP and restrictive EDs. A narrative review of the literature on CFAP and EDs was performed using PubMed, JSTOR, ScienceDirect, and PsycINFO and the following search terms: 'restrictive eating disorders', 'chronic functional abdominal pain', 'chronic pain' 'treatment' 'diagnosis' and 'adolescents'. Published studies on restrictive EDs and CFAP from May 2008 to March 2023 were included. Ascribable to the overlap in etiology and symptom presentation, adolescents with chronic pain are significantly less likely to have their ED pathology promptly identified by providers compared to adolescents without comorbid chronic pain. This highlights the importance of the time sensitive and accurate identification of EDs in adolescents with CFAP. Overall, assessment methods are limited and EDs take longer to be identified in adolescents with comorbid CFAP. Future efforts should address diagnostic practices in pediatric settings and improve the communication among medical and mental health providers in order to promote the rapid and effective diagnosis and treatment of comorbid CFAP and EDs.
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Affiliation(s)
- Emily A. Beckmann
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Claire M. Aarnio-Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
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7
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Sawada A, Sifrim D. How to recognize and treat rumination syndrome. Curr Opin Gastroenterol 2023; 39:340-346. [PMID: 37097822 DOI: 10.1097/mog.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Rumination syndrome (RS) is a functional gastroduodenal disorder characterized by repeated effortless regurgitation or vomiting of recently ingested food without retching. RS generally has been considered a rare entity. However, it has been increasingly recognized that many RS patients are likely to be underdiagnosed. This review discusses how to recognize and manage RS patients in clinical practice. RECENT FINDINGS A recent epidemiological study that included over 50,000 individuals found that the prevalence of RS around the world is 3.1%. In patients with proton pump inhibitor (PPI)-refractory reflux symptoms, postprandial high-resolution manometry combined with impedance (HRM/Z) reveals that RS accounts for up to 20% of those cases. HRM/Z can be a gold standard for objective RS diagnosis. In addition, off-PPI 24-h impedance pH monitoring can suggest the possibility of RS when it reveals frequent postprandial, non-acid reflux with a high symptom index. Modulated cognitive behavioral therapy (CBT) targeting secondary psychological maintaining mechanisms almost eliminates regurgitation. SUMMARY The prevalence of RS is higher than generally thought. For patients suspected of RS, HRM/Z is useful to distinguish RS from gastroesophageal reflux disease. CBT can be a highly effective therapeutic option.
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Affiliation(s)
- Akinari Sawada
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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8
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Carpinelli L, Savarese G, Pascale B, Milano WD, Iovino P. Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms. Nutrients 2023; 15:nu15112501. [PMID: 37299464 DOI: 10.3390/nu15112501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms. METHODS Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire. RESULTS A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust. CONCLUSIONS AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.
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Affiliation(s)
- Luna Carpinelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi Campus, University of Salerno, 84081 Baronissi, Italy
| | - Giulia Savarese
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi Campus, University of Salerno, 84081 Baronissi, Italy
| | - Biagio Pascale
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi Campus, University of Salerno, 84081 Baronissi, Italy
| | | | - Paola Iovino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Baronissi Campus, University of Salerno, 84081 Baronissi, Italy
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9
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Atkins M, Burton Murray H, Staller K. Assessment and management of disorders of gut-brain interaction in patients with eating disorders. J Eat Disord 2023; 11:20. [PMID: 36782302 PMCID: PMC9926752 DOI: 10.1186/s40337-022-00731-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
Disorders of gut-brain interaction (DBGI), also known as functional gastrointestinal disorders, are common in individuals with eating disorders, and may precede or perpetuate disordered eating. Understanding the pathophysiology of common gastrointestinal symptoms in DGBI can be important for the care of many patients with eating disorders. In this review, we summarize the literature to date on the complex relationship between DBGI and eating disorders and provide guidance on the assessment and management of the most common symptoms of DBGI by anatomic region: esophageal symptoms (globus and functional dysphagia), gastroduodenal symptoms (functional dyspepsia and nausea), and bowel symptoms (abdominal pain, bloating and constipation).
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Affiliation(s)
- Micaela Atkins
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.
| | - Helen Burton Murray
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, USA
| | - Kyle Staller
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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10
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Dhopatkar N, Keeler JL, Mutwalli H, Whelan K, Treasure J, Himmerich H. Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in anorexia nervosa: A review of mechanistic rationale and clinical evidence. Psychoneuroendocrinology 2023; 147:105959. [PMID: 36327759 DOI: 10.1016/j.psyneuen.2022.105959] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Recent research has revealed the pivotal role that the gut microbiota might play in psychiatric disorders. In anorexia nervosa (AN), the gut microbiota may be involved in pathophysiology as well as in the gastrointestinal (GI) symptoms commonly experienced. This review collates evidence for the potential role of gut microbiota in AN, including modulation of the immune system, the gut-brain axis and GI function. We examined studies comparing gut microbiota in AN with healthy controls as well as those looking at modifications in gut microbiota with nutritional treatment. Changes in energy intake and nutritional composition influence gut microbiota and may play a role in the evolution of the gut microbial picture in AN. Additionally, some evidence indicates that pre-morbid gut microbiota may influence risk of developing AN. There appear to be similarities in gut microbial composition, mechanisms of interaction and GI symptoms experienced in AN and other GI disorders such as inflammatory bowel disease and functional GI disorders. Probiotics and prebiotics have been studied in these disorders showing therapeutic effects of probiotics in some cases. Additionally, some evidence exists for the therapeutic benefits of probiotics in depression and anxiety, commonly seen as co-morbidities in AN. Moreover, preliminary evidence for the use of probiotics in AN has shown positive effects on immune modulation. Based on these findings, we discuss the potential therapeutic role for probiotics in ameliorating symptoms in AN.
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Affiliation(s)
- Namrata Dhopatkar
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK.
| | - Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Hiba Mutwalli
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK.
| | - Janet Treasure
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Hubertus Himmerich
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK; Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
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11
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Fischer LK, Schreyer CC, Pletch A, Cooper M, Vanzhula IA, Redgrave GW, Guarda AS. Monitoring and treating hypoglycemia during meal-based rapid nutritional rehabilitation in patients with extreme anorexia nervosa. Eat Weight Disord 2022; 27:3301-3308. [PMID: 35994205 DOI: 10.1007/s40519-022-01460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/23/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Hypoglycemia, a complication of prolonged starvation, can be life-threatening and is presumed to contribute to the high mortality of anorexia nervosa. Furthermore, early refeeding in severe anorexia nervosa can precipitate paradoxical post-prandial hypoglycemia. Few studies have analyzed the course of hypoglycemia during nutritional rehabilitation in patients with extremely low-weight anorexia nervosa. No standard practice guidelines exist and recommended strategies for managing hypoglycemia (i.e., nasogastric feeds, high-fat diets) have limitations. METHODS This cohort study assessed prevalence and correlates of hypoglycemia in 34 individuals with very low body mass index (BMI < 14.5 kg/m2) anorexia nervosa treated in an intensive eating disorders program with an exclusively meal-based rapid weight gain nutritional protocol. Hypoglycemia was monitored with frequent point of care (POC) glucose testing and treated with oral snacks and continuous slow intravenous 5% dextrose in 0.45% saline (IV D5 1/2 NS) infusion. RESULTS POC hypoglycemia was detected in 50% of patients with highest prevalence noted on the day of admission. Hypoglycemia resolved during the first week of hospitalization in most cases and was generally asymptomatic. Seven patients (20.6%) experienced at least one episode of severe hypoglycemia with POC glucose < 50 mg/dl. Lower admission BMI was associated with higher likelihood of developing hypoglycemia and longer duration of hypoglycemia. CONCLUSION Meal-based management of hypoglycemia supplemented by continuous IV D5 1/2 NS appears a viable alternative to alternate strategies such as enteral tube feeding. We discuss recommendations for hypoglycemia monitoring during nutritional rehabilitation and directions for future research. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Laura K Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA.,Childrens National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA
| | - Allisyn Pletch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA
| | - Irina A Vanzhula
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA. .,Department of Psychiatry and Behavioral Science, Johns Hopkins Eating Disorders Program, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 101, Baltimore, MD, 21287, USA.
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12
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Han YJ, Roy S, Siau AMPL, Majid A. Binge-eating and sodium bicarbonate: a potent combination for gastric rupture in adults-two case reports and a review of literature. J Eat Disord 2022; 10:157. [PMID: 36348449 PMCID: PMC9643985 DOI: 10.1186/s40337-022-00677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disordered eating behaviour including binge-eating often results in significant medical conditions, which are at times fatal. It can result in acute gastric dilatation which can lead to ischemic necrosis and stomach rupture. Dyspepsia and bloating are common symptoms following binge eating. Patients commonly use over-the-counter medications like sodium bicarbonate or home remedies for relief. However, in very rare, reported cases, sodium bicarbonate has been attributed to cause acute gastric dilatation and spontaneous gastric rupture instead. METHODS We report two cases of spontaneous gastric rupture following consumption of sodium bicarbonate containing antacids after a large meal, and a review of the literature of similar cases. RESULTS A total of 36 cases were identified. Approximately half of the cases (47.2%) were correlated with eating disorders, with higher prevalence in females (69%) and a very high mortality rate (41.6%). Amongst the 36 cases, sodium bicarbonate ingestion was associated with 10 cases. The lesser curvature (36.1%) and anterior wall (33.3%) are the most common sites of rupture. Associated causes include binge-eating, gas release from sodium bicarbonate, gastric content fermentation, proximal and distal outlet obstruction, and muscular atony. DISCUSSION Sudden distension and impaired emptying mechanism of the stomach is necessary for spontaneous gastric rupture to occur. Acute gastric dilatation with perforation requires definitive surgical management. There should be a low threshold of suspicion for patients presenting with severe abdominal pain and abdominal distension following an episode of binge-eating. There is a need for patient education around the use of over-the-counter medications or home remedies.
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Affiliation(s)
- You Jin Han
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
| | - Susmit Roy
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia. .,Calvary Mater Hospital, Newcastle, Edith & Platt St, Waratah, Newcastle, NSW, 2298, Australia. .,University of Newcastle, Newcastle, Australia.
| | - Ashley Maria Pei Ling Siau
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
| | - Adeeb Majid
- Calvary Mater Hospital, Newcastle, Edith & Platt St, Waratah, Newcastle, NSW, 2298, Australia
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13
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Associations among perceived taste and smell sensitivity, gastrointestinal symptoms, and restrictive eating in a community sample of adults. Eat Behav 2022; 46:101647. [PMID: 35763980 DOI: 10.1016/j.eatbeh.2022.101647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/06/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
Abstract
Restrictive eating is associated with several poor health outcomes. Exteroceptive sensory modalities, including taste and smell, are employed while eating and disturbances in exteroceptive sensitivity may influence eating behavior. Meal-related gastrointestinal disturbances, such as early satiety and postprandial fullness, are well-documented in eating disorders and may influence eating behavior. This study examined the relationships of perceived sensitivity to taste or smell and gastrointestinal symptoms with restrictive eating, and potential interactions between gastrointestinal symptoms and perceived sensitivity to taste or smell. Adults aged 18-65 were recruited via ResearchMatch.org (N = 420) and completed questionnaires assessing restrictive eating, perceived sensitivity to taste and smell, and gastrointestinal symptom severity. There was a weak relationship between restrictive eating and perceived sensitivity to taste (r = -0.115, p = .022) and smell (r = -0.101, p = .039). There was a strong relationship between gastrointestinal symptom severity and restrictive eating (r = 0.583, p < .001). Gastrointestinal symptom severity moderated the relationship between perceived sensitivity to taste and restrictive eating, such that this relationship was strongest at lower levels of gastrointestinal symptom severity (Estimate = -0.136, p = .014). There was no observed interaction between perceived sensitivity to smell and gastrointestinal symptoms (Estimate = 0.001, p = .156). Results indicate that increased perceived sensitivity to taste, smell, and gastrointestinal symptom severity were each associated with greater restrictive eating. The relationship between perceived sensitivity to taste and restrictive eating is strongest at lower gastrointestinal symptom severity. Future research should examine whether tailoring treatments for individuals who present with elevated perceived sensitivity to taste or smell, gastrointestinal symptoms, or both is effective in reducing restrictive eating.
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14
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Josefsson A, Hreinsson JP, Simrén M, Tack J, Bangdiwala SI, Sperber AD, Palsson OS, Törnblom H. Global Prevalence and Impact of Rumination Syndrome. Gastroenterology 2022; 162:731-742.e9. [PMID: 34774539 DOI: 10.1053/j.gastro.2021.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Rumination syndrome is a Disorder of Gut-Brain Interaction (DGBI) of unknown etiology. We aimed to assess its global prevalence and potential associations with other medical conditions. METHODS Data were collected via the Internet in 26 countries. Subjects were evenly distributed by country, sex, and age groups and were invited for a "health survey" using the Rome IV diagnostic questionnaire and a supplementary questionnaire addressing factors potentially associated with DGBI. RESULTS In all, 54,127 subjects completed the survey (51% male; mean age, 44.3 years). The overall prevalence of rumination syndrome was 3.1% (95% confidence interval [CI], 3.0-3.3%). It was highest in Brazil (5.5% CI, 4.5-6.5) and lowest in Singapore (1.7% CI, 1.1-2.2). The mean age of people with rumination syndrome was 44.5 years (standard deviation, 15.6) and it was more common in females (54.5% vs 45.5%). Factors independently associated with rumination syndrome were depression (odds ratio [OR], 1.46), anxiety (OR, 1.8), body mass index (OR, 1.04), and female sex (OR, 1.19). Subjects with multiple DGBI were at increased risk of having rumination syndrome, with the highest risk in subjects with 4 gastrointestinal regions with DGBI (OR, 15.9 compared with none). Quality of life (QoL) was lower in subjects with rumination syndrome compared with the rest of the cohort (PROMIS-10 score: physical QoL mean 12.9 vs 14.5; mental QoL mean 12.0 vs 13.6). CONCLUSIONS The prevalence of rumination syndrome is higher than reported in most previous population studies and is likely underdiagnosed in clinical practice. Awareness of rumination syndrome should be raised among clinicians to improve care for these patients.
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Affiliation(s)
- Axel Josefsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Jóhann P Hreinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jan Tack
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Olafur S Palsson
- Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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Eating and Psychiatric Disorders Are Independent Risk Factors for Rumination Syndrome. J Clin Gastroenterol 2022; 56:228-233. [PMID: 33988353 DOI: 10.1097/mcg.0000000000001510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/25/2021] [Indexed: 12/19/2022]
Abstract
GOAL The goal of this study was to evaluate whether a history of eating disorders (EDs) or psychiatric disorders (PDs) are risk factors for rumination syndrome (RS). BACKGROUND RS is a disorder of gut-brain interaction characterized by an effortless postprandial retrograde flow of ingested contents. Disorder of gut-brain interactions have been associated with psychiatric and behavioral comorbidities. No prior comparative study has assessed the relationship between RS and ED or PD. METHODS This was a case-control study of adults with RS at a tertiary center in January 2013 to January 2018. Two age-matched/gender-matched controls per RS case were identified. The Fisher exact test (categorical)/Student t test (continuous) and forward stepwise logistic regression were performed for univariate and multivariable analyses, respectively. RESULTS Seventy-two patients (24 cases/48 controls) were included. Baseline demographics and characteristics were similar between cases and controls. Among RS patients, 9 (37.5%) had a history of ED, including 3 (12.5%) anorexia nervosa and 4 (16.7%) bulimia nervosa; and 20 (83.3%) had a PD, including 9 (37.5%) anxiety and 7 (29.2%) depression. Prevalence of ED (37.5% vs. 4.2%, P=0.0002) and PD (83.3% vs. 50.0%, P=0.0062) were higher among RS patients than controls. Specifically, the risks of anorexia nervosa (16.7% vs. 0%, P=0.005) and bulimia nervosa (21.1% vs. 0%, P=0.001) were both increased in RS patients. On multivariable analysis, ED (adjusted odds ratio=16.4, P=0.0033) and PD (adjusted odds ratio=4.47, P=0.029) remained independent predictors for RS. CONCLUSIONS A history of ED and PD were independent risk factors for RS. Abnormal eating behaviors and psychiatric comorbidities may contribute to the pathogenesis of RS. Evaluation of RS should include a detailed history for ED and PD.
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16
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Sasegbon A, Hasan SS, Disney BR, Vasant DH. Rumination syndrome: pathophysiology, diagnosis and practical management. Frontline Gastroenterol 2022; 13:440-446. [PMID: 36046491 PMCID: PMC9380772 DOI: 10.1136/flgastro-2021-101856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/28/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Syed Shariq Hasan
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Benjamin R Disney
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Dipesh Harshvadan Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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17
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Simons M, Taft TH, Doerfler B, Ruddy JS, Bollipo S, Nightingale S, Siau K, van Tilburg MAL. Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome. Neurogastroenterol Motil 2022; 34:e14188. [PMID: 34254719 DOI: 10.1111/nmo.14188] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Dietary treatments are growing in popularity as interventions for chronic digestive conditions. Patients with irritable bowel syndrome (IBS) often change their eating behaviors to mitigate symptoms. This can occur under the direction of their physician, a dietitian, or be self-directed. Poorly implemented and monitored diet treatments occur frequently with considerable risks for negative consequences. We aim to review the literature related to dietary treatments and risks associated with nutritional deficiencies and disordered eating. METHODS Searches were conducted from June to December 2020 on PubMed, MEDLINE, EMBASE, DARE and the Cochrane Database of Systematic Reviews using relevant keywords based on the Patient, Intervention, Comparator and Outcome (PICO) format. Studies included both adult and pediatric populations. Results are synthesized into a narrative review. RESULTS While dietary approaches are efficacious in many research studies, their translation to clinical practice has been less clear. Patients with IBS are at risk for nutritional deficiencies, disordered eating, increased anxiety, and decreases in quality of life in both adult and pediatric groups. CONCLUSIONS Physicians prescribing dietary treatment for IBS should be aware of nutritional and psychological risks and implement mitigation measures. These include using a combination of brief, validated questionnaires and clinical history, and collaboration with registered dietitians and/or psychologists. Recommendations for clinical decisions are provided.
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Affiliation(s)
- Madison Simons
- Division of Gastroenterology & Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tiffany H Taft
- Division of Gastroenterology & Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bethany Doerfler
- Division of Gastroenterology & Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Steven Bollipo
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Scott Nightingale
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Keith Siau
- The Dudley Group, NHS Foundation Trust, Dudley, UK
| | - Miranda A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
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18
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Riedlinger C, Mazurak N, Schäffeler N, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment. Front Psychiatry 2022; 13:962837. [PMID: 36061281 PMCID: PMC9436028 DOI: 10.3389/fpsyt.2022.962837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN. METHODS In weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models. RESULTS Abdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation. CONCLUSIONS Informing patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), 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
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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19
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Žaja O, Fiolić M, Ćuk MC, Tiljak MK. "The role of L. reuteri DSM17938 in nutritional recovery and treatment of constipation in children and adolescents with anorexia nervosa - a randomized, double blind, placebo controlled study". Clin Nutr ESPEN 2021; 46:47-53. [PMID: 34857236 DOI: 10.1016/j.clnesp.2021.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) carries the risk of potentially irreversible medical complications, especially in children and adolescents. Constipation is frequent and difficult to manage. Due to the symptoms it causes, constipation can further compromise nutritional rehabilitation. OBJECTIVE To investigate the role of probiotics (Lactobacillus reuteri DSM 17938) in children and adolescent with AN. DESIGN, SETTING AND PARTICIPANTS Randomized, double blind, placebo controlled study in 31 female pediatric AN patients with constipation, referred to nutritional therapy in Pediatric Gastroenterology Department, Sestre milosrdnice University Hospital Centre in Zagreb. METHODS At hospitalization, patients were randomly assigned into two groups; one taking L. reuteri, and other placebo for 3 months, along with the conventional nutritional rehabilitation. Patients were followed 3 months after stopping the treatment. The primary outcome was relief of constipation, assessed after 3 months, while secondary outcomes were normalization of body weight, stool frequency and consistency, relief of dyspepsia, weight gain and recovery of malnutrition regarding bone density and vitamin D3 levels. RESULTS The study showed statistically significant difference between the two groups considering the stool frequency (6.4 vs. 4.2 stools/week; p < 0.05) and normalization of body weight (93 vs. 63%; p = 0.04) after 6 months, but no significant effect on the rate of relief of constipation (87 vs. 64%; p = 0.22) at 3 months. In the L. reuteri group, the normalization of BMD was achieved in 8/15, whereas in the placebo group, in 3/16 patients. However, there was no statistically significant difference compared to the placebo group regarding the BMD recovery as well as the normalization of D3 levels (p = 0.056). CONCLUSIONS Probiotics may serve as simple and safe adjuvant therapy of constipation in childhood AN and contribute to faster nutritional recovery. Although a statistically significant difference between the two group in relief of constipation could not be shown after 3 months, a benefit from probiotics could be in increasing stool frequency and nutritional recovery in childhood AN after six months. Registered under ClinicalTrials.gov Identifier no. NCT02004288.
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Affiliation(s)
- Orjena Žaja
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; University of Zagreb, School of Dental Medicine, Croatia
| | | | - Matea Crnković Ćuk
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
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20
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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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21
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Murray HB, Pasricha TS, Jehangir A, Thomas JJ, Kuo B, Parkman HP. Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation. Neurogastroenterol Motil 2021; 33:e14103. [PMID: 33729638 DOI: 10.1111/nmo.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rumination syndrome involves effortless, repeated regurgitation, and can overlap with other upper gastrointestinal disorders, including gastroparesis. To inform better diagnostic detection of rumination, we aimed to (1) identify frequency and characteristics of rumination in patients presenting for gastric symptom evaluation; and (2) assess demographic and clinical characteristics that could differentiate those with versus those without rumination. METHODS Consecutively referred patients to two tertiary academic centers for gastric symptom specialty evaluation were included (N = 242). We obtained demographic information, gastric emptying scintigraphy, upper gastrointestinal symptoms using the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM), and Rome IV-based rumination questionnaire. KEY RESULTS Thirty-one of the 242 (12.8%) patients met criteria for rumination syndrome, of which 48% reported associated psychosocial impairment. Comparing those with rumination and those without, there were no differences in race, gender, frequency of diabetes, or frequency of gastroparesis. The median PAGI-SYM score for rumination patients was higher than for those without (3.03 vs. 2.55; unadjusted p = 0.043, adjusted p = 0.30). This was largely driven by increased heartburn/regurgitation subscale scores (2.71 vs. 1.57, unadjusted p = 0.0067, adjusted p = 0.046), itself influenced by elevated daytime regurgitation/reflux (3.0 vs. 2.0; unadjusted p = 0.007, adjusted p = 0.048). There were no significant differences on the remaining PAGI-SYM subscales. CONCLUSIONS AND INFERENCES Rumination syndrome determined by Rome IV criteria was present in 12.8% of patients presenting for gastric symptom evaluation. Higher self-report PAGI-SYM heartburn/regurgitation subscale scores, particularly daytime regurgitation/reflux symptoms, were the only parameters that distinguished rumination. The PAGI-SYM heartburn/regurgitation subscale could be used to screen for rumination, in addition to GERDAQ6.
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Affiliation(s)
- Helen Burton Murray
- Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Trisha S Pasricha
- Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Asad Jehangir
- Gastroenterology Division, Temple University Hospital, Philadelphia, PA, USA
| | - Jennifer J Thomas
- Harvard Medical School, Boston, MA, USA.,Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Braden Kuo
- Division of Gastroenterology, Department of Medicine, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Henry P Parkman
- Gastroenterology Division, Temple University Hospital, Philadelphia, PA, USA
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22
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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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23
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Wiklund CA, Rania M, Kuja-Halkola R, Thornton LM, Bulik CM. Evaluating disorders of gut-brain interaction in eating disorders. Int J Eat Disord 2021; 54:925-935. [PMID: 33955041 PMCID: PMC10751984 DOI: 10.1002/eat.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders commonly co-occur with gastrointestinal problems. This case-control study aimed to (a) document the prevalence of disorders of gut-brain interaction (DGBI) in eating disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI. METHOD We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms. RESULTS A large majority (88.2-95.5%) of individuals with eating disorders reported at least one DGBI and 34.8-48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9-58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03-3.34) than those with low current symptoms (1.60-1.84). DISCUSSION The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients.
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Affiliation(s)
- Camilla A Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Rania
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Alcala-Gonzalez LG, Serra X, Barba E. Rumination syndrome: Critical review. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:155-163. [PMID: 34023479 DOI: 10.1016/j.gastrohep.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Abstract
Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. Clinically, it is characterized by repeated episodes of effortless food regurgitation. The most usual complaint is frequent vomiting. The physical mechanism that generates regurgitation events is dependent on an involuntary process that alters abdominal and thoracic pressures accompanied by a permissive oesophageal-gastric junction. The diagnosis of rumination syndrome is clinical, highlighting the importance of performing an exhaustive anamnesis on the characteristics of the symptoms. Complementary tests are used to corroborate the diagnosis or rule out organic pathology. Treatment is focused on behavioural therapies as the first line, reserving pharmacological and surgical therapies for refractory cases.
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Affiliation(s)
- Luis Gerardo Alcala-Gonzalez
- Departamento de Gastroenterología, Vall d'Hebron Hospital Universitari, Vall d'Hebron, Barcelona, España; Facultad de Medicina(,) Universitat Autònoma de Barcelona, Bellaterra, España
| | - Xavier Serra
- Departamento de Gastroenterología, Vall d'Hebron Hospital Universitari, Vall d'Hebron, Barcelona, España
| | - Elizabeth Barba
- Departamento de Gastroenterología, Unidad de Motilidad Digestiva, Hospital Clínic, Barcelona, España.
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25
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Galmiche M, Achamrah N, Déchelotte P, Ribet D, Breton J. Role of microbiota-gut-brain axis dysfunctions induced by infections in the onset of anorexia nervosa. Nutr Rev 2021; 80:381-391. [PMID: 34010427 DOI: 10.1093/nutrit/nuab030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by low food intake, severe body weight loss, intense fear of gaining weight, and dysmorphophobia. This chronic disease is associated with both psychiatric and somatic comorbidities. Over the years, clinical studies have accumulated evidence that viral or bacterial infections may promote the onset of eating disorders such as AN. This review aims to describe how infections and the subsequent immune responses affect food intake regulation in the short term and also how these processes may lead to long-term intestinal disorders, including gut barrier disruption and gut microbiota dysbiosis, even after the clearance of the pathogens. We discuss in particular how infection-mediated intestinal dysbiosis may promote the onset of several AN symptoms and comorbidities, including appetite dysregulation, functional gastrointestinal disorders, and mood disorders.
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Affiliation(s)
- Marie Galmiche
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Najate Achamrah
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Pierre Déchelotte
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - David Ribet
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
| | - Jonathan Breton
- M. Galmiche, N. Achamrah, P. Déchelotte, and J. Breton are with Nutrition Department, CHU Rouen, F-76000 Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, INSERM UMR 1073, Nutrition, Gut and Brain Laboratory, Rouen, France. N. Achamrah, P. Déchelotte, D. Ribet, and J. Breton are with the UNIROUEN, Institute for Research and Innovation in Biomedicine, Normandie University, Rouen, France
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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
There are several online tools, books, and applications available to enhance the application of nutrition interventions for gastroenterologists and patients with gastrointestinal (GI) disorders. Nutritional health may be compromised in GI patients because of the nature of the disease impacting use of nutritional substrates or reducing oral intake. Protein-calorie malnutrition can result from insufficient intake, malabsorption of nutrients, and increased energy expenditure, all of which can occur in certain GI conditions. Eating disorders and disordered eating, and food insecurity, also impact nutritional status. Therapeutic nutrition interventions should be implemented with guidance of a registered dietitian with expertise in their application.
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Affiliation(s)
- Kate Scarlata
- For a Digestive Peace of Mind, LLC, 11 Pine Street, Medway, MA 02053, USA.
| | - Emily Haller
- Division of Gastroenterology, Michigan Medicine, University of Michigan, 3912 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:163-171. [PMID: 33602544 DOI: 10.1016/j.rgmx.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. In those patients, retrograde flow of the ingested gastric content into the mouth is produced due to a simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure. The estimated prevalence is around 2% in the general adult population. The main clinical characteristics include: a) early postprandial regurgitation, b) the effortlessly regurgitated material is similar to the ingested food, c) the regurgitated material is spit out or swallowed again. The clinical diagnosis of rumination syndrome relies on the clinical criteria. High resolution esophageal manometry, ideally including impedance monitoring, can be an important adjunct for making the clinical diagnosis. Its management is based on instruction as to the nature of the pathology, education in postprandial diaphragmatic breathing, and the assessment of possible psychiatric comorbidity. Baclofen use is reserved for second-line treatment in patients with refractory symptoms.
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Affiliation(s)
- J Chahuan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Rey
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile
| | - H Monrroy
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile.
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Skowron K, Kurnik-Łucka M, Dadański E, Bętkowska-Korpała B, Gil K. Backstage of Eating Disorder-About the Biological Mechanisms behind the Symptoms of Anorexia Nervosa. Nutrients 2020; 12:E2604. [PMID: 32867089 PMCID: PMC7551451 DOI: 10.3390/nu12092604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Anorexia nervosa (AN) represents a disorder with the highest mortality rate among all psychiatric diseases, yet our understanding of its pathophysiological components continues to be fragmentary. This article reviews the current concepts regarding AN pathomechanisms that focus on the main biological aspects involving central and peripheral neurohormonal pathways, endocrine function, as well as the microbiome-gut-brain axis. It emerged from the unique complexity of constantly accumulating new discoveries, which hamper the ability to look at the disease in a more comprehensive way. The emphasis is placed on the mechanisms underlying the main symptoms and potential new directions that require further investigation in clinical settings.
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Affiliation(s)
- Kamil Skowron
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Magdalena Kurnik-Łucka
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Emil Dadański
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Barbara Bętkowska-Korpała
- Department of Psychiatry, Jagiellonian University Medical College, Institute of Medical Psychology, Jakubowskiego St 2, 30-688 Krakow, Poland;
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
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30
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Kessler U, Rekkedal GÅ, Rø Ø, Berentsen B, Steinsvik EK, Lied GA, Danielsen Y. Association between gastrointestinal complaints and psychopathology in patients with anorexia nervosa. Int J Eat Disord 2020; 53:532-536. [PMID: 32040232 DOI: 10.1002/eat.23243] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gastrointestinal (GI) symptoms appear frequently in patients with anorexia nervosa (AN), but the associations between psychopathological, GI, and eating disorder (ED) symptoms remain unclear. This study aimed to determine the relationships of GI complaints with psychopathological measures, ED symptoms, and body mass index (BMI) in patients with AN. METHOD Thirty outpatients with AN aged >16 years were included. Psychopathological measures (Symptom Checklist-90-Revised, Beck Depression Inventory-II, and Beck Anxiety Inventory), ED symptoms (Eating Disorder Examination Questionnaire), ED-associated impairment (Clinical Impairment Assessment Questionnaire), GI complaints (Irritable Bowel Syndrome Severity Scoring System [IBS-SSS]), and BMI were assessed prior to starting treatment, and correlation and multiple regression analyses were applied to data from 19 patients. RESULTS IBS-symptoms were significantly correlated only with ED symptoms (r = 0.583, p = .009) and somatization (r = 0.666, p = .002). Multiple regression analysis revealed that somatization significantly predicted worse IBS symptoms (beta = 0.5, p = .04), while ED symptoms did not. DISCUSSION Higher IBS-SSS scores were associated with higher severities of other somatic complaints. GI complaints and somatization should be addressed in treatments for AN in order to prevent these factors impeding the establishment of healthy eating patterns. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745067.
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Affiliation(s)
- Ute Kessler
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Guro Å Rekkedal
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Birgitte Berentsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Center for Functional Gastrointestinal Disorders, Medical Department, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth K Steinsvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Center for Functional Gastrointestinal Disorders, Medical Department, Haukeland University Hospital, Bergen, Norway
| | - Gülen A Lied
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Center for Functional Gastrointestinal Disorders, Medical Department, Haukeland University Hospital, Bergen, Norway
| | - Yngvild Danielsen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Vachhani H, Ribeiro BDS, Schey R. Rumination Syndrome: Recognition and Treatment. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:60-68. [PMID: 31960280 DOI: 10.1007/s11938-020-00272-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to discuss current diagnostic and treatments of rumination. Rumination is often underdiagnosed or misdiagnosed in adults, especially when symptoms suggest regurgitation rather than vomiting accompanied by re-chewing and re-swallowing and should be included in the differential diagnosis. It is primarily diagnosed clinically by ROME-IV or DSM-5. RECENT FINDINGS That rumination can be re-affirmed by characteristic patterns on objective testing such as high-resolution esophageal manometry and 24-h pH impedance testing. However, although gastroduodenal manometry and EMG are helpful, these tests are slowly losing interest given their technical nature of data gathering, time consumption, cost burden, and patient discomfort. SUMMARY Rumination is primarily diagnosed clinically by ROME-IV or DSM-5 in addition to high-resolution esophageal manometry and 24-h pH impedance. Management is challenging and usually a combination of behavioral, pharmacological, and rarely surgical treatment. Recent data demonstrate that the combination of behavioral techniques such as diaphragmatic breathing exercises and/or with baclofen has promising results. Further research is necessary to further define objective criteria for diagnosis and other therapeutic modalities for treatment.
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Affiliation(s)
- Herit Vachhani
- Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Bruno De Souza Ribeiro
- Neurogastroenterology & Esophageal Program, University of Florida College of Medicine-Jacksonville, Building 1, Suite 300, 4555 Emerson Street, Jacksonville, FL, 32207, USA
| | - Ron Schey
- Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
- Neurogastroenterology & Esophageal Program, University of Florida College of Medicine-Jacksonville, Building 1, Suite 300, 4555 Emerson Street, Jacksonville, FL, 32207, USA.
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Craven A, Foo J, Sweeney T. Acute gastric dilation and necrosis from binge eating in anorexia nervosa. ANZ J Surg 2020; 90:2133-2135. [PMID: 32100407 DOI: 10.1111/ans.15780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Alexander Craven
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jonathan Foo
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Thomas Sweeney
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
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33
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Eating Disorders and Gastrointestinal Diseases. Nutrients 2019. [PMID: 31842421 DOI: 10.3390/nu11123038.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Eating disorders (ED) are frequently associated with a wide range of psychiatric or somatic comorbidities. The most relevant ED are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED). Patients with ED exhibit both upper and lower gastrointestinal (GI) symptoms. Evidence of alterations throughout the GI tract in ED will be analyzed given the role of the GI tract in food intake and its regulation. It remains a matter of debate whether GI disorders are inherent manifestations of ED or the results of malnutrition occurring from ED. Moreover, recent clinical studies have highlighted the growing role of intestinal microbiota in the pathogenesis of ED, making it possible to hypothesize a modulation of intestinal microbiota as a co-adjuvant to standard therapy. The aim of this review is to analyze the link between ED and GI diseases and to present, where known, the potential key factors underlying these conditions. Conclusions: The presence of GI disorders should be investigated in patients with ED. Screening for ED should also be encouraged in individuals seeking treatment for unexplained GI complaints to better address therapeutic issues that surround these difficult medical conditions.
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34
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Santonicola A, Gagliardi M, Guarino MPL, Siniscalchi M, Ciacci C, Iovino P. Eating Disorders and Gastrointestinal Diseases. Nutrients 2019; 11:nu11123038. [PMID: 31842421 PMCID: PMC6950592 DOI: 10.3390/nu11123038] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (ED) are frequently associated with a wide range of psychiatric or somatic comorbidities. The most relevant ED are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED). Patients with ED exhibit both upper and lower gastrointestinal (GI) symptoms. Evidence of alterations throughout the GI tract in ED will be analyzed given the role of the GI tract in food intake and its regulation. It remains a matter of debate whether GI disorders are inherent manifestations of ED or the results of malnutrition occurring from ED. Moreover, recent clinical studies have highlighted the growing role of intestinal microbiota in the pathogenesis of ED, making it possible to hypothesize a modulation of intestinal microbiota as a co-adjuvant to standard therapy. The aim of this review is to analyze the link between ED and GI diseases and to present, where known, the potential key factors underlying these conditions. Conclusions: The presence of GI disorders should be investigated in patients with ED. Screening for ED should also be encouraged in individuals seeking treatment for unexplained GI complaints to better address therapeutic issues that surround these difficult medical conditions.
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Affiliation(s)
- Antonella Santonicola
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Salerno, Italy; (A.S.); (M.G.); (M.S.); (C.C.)
| | - Mario Gagliardi
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Salerno, Italy; (A.S.); (M.G.); (M.S.); (C.C.)
| | | | - Monica Siniscalchi
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Salerno, Italy; (A.S.); (M.G.); (M.S.); (C.C.)
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Salerno, Italy; (A.S.); (M.G.); (M.S.); (C.C.)
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84084 Salerno, Italy; (A.S.); (M.G.); (M.S.); (C.C.)
- Correspondence: ; Tel.: +39-089965030/+39-3357822672
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35
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Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis. J Clin Psychol Med Settings 2019; 28:40-52. [DOI: 10.1007/s10880-019-09685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gosseaume C, Dicembre M, Bemer P, Melchior JC, Hanachi M. Somatic complications and nutritional management of anorexia nervosa. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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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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38
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Makhzoumi SH, Schreyer CC, Hansen JL, Laddaran LA, Redgrave GW, Guarda AS. Hospital course of underweight youth with ARFID treated with a meal-based behavioral protocol in an inpatient-partial hospitalization program for eating disorders. Int J Eat Disord 2019; 52:428-434. [PMID: 30779365 DOI: 10.1002/eat.23049] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Information on nutritional rehabilitation for underweight patients with avoidant/restrictive food intake disorder (ARFID) is scarce. This study characterized hospitalized youth with ARFID treated in an inpatient (IP)-partial hospitalization behavioral eating disorders (EDs) program employing an exclusively meal-based rapid refeeding protocol and compared weight restoration outcomes to those of patients with anorexia nervosa (AN). METHOD Data from retrospective chart review of consecutive underweight admissions (N = 275; age 11-26 years) with ARFID (n = 27) were compared to those with AN (n = 248) on clinical features, reason for discharge, and weight restoration variables. For patients with ARFID, presenting phenomenology was further characterized by detailed chart review. RESULTS At admission, 53% of patients with ARFID were vomiting regularly. The predominant ARFID subtype was ARFID-aversive, with close to a third being mixed subtype. Gastrointestinal (GI) symptomatology (81.5%) was the most commonly endorsed reason for restriction. A third had undergone unsuccessful parenteral or enteral tube feeding. Patients with ARFID were more likely male, had higher admission BMI, and slower IP weight gain (1.36 kg /week vs 1.92) compared to patients with AN. Fewer patients with ARFID transitioned to the partial hospitalization program, although the proportion discharged for clinical improvement did not differ and both groups had a mean program discharge BMI >18.5. DISCUSSION GI symptoms appear a common contributor to restrictive eating amongst hospitalized youth with ARFID. Despite a slightly lower rate of IP weight gain, clinical improvement and weight restoration at discharge were similar for patients with ARFID compared to AN.
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Affiliation(s)
- Saniha H Makhzoumi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lori A Laddaran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews. J Clin Med 2019; 8:jcm8020278. [PMID: 30823566 PMCID: PMC6406645 DOI: 10.3390/jcm8020278] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.
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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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Hanachi M, Manichanh C, Schoenenberger A, Pascal V, Levenez F, Cournède N, Doré J, Melchior JC. Altered host-gut microbes symbiosis in severely malnourished anorexia nervosa (AN) patients undergoing enteral nutrition: An explicative factor of functional intestinal disorders? Clin Nutr 2018; 38:2304-2310. [PMID: 30527539 DOI: 10.1016/j.clnu.2018.10.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 09/07/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Functional intestinal disorders (FIDs) are frequently observed in patients with anorexia nervosa (AN). Relationship between FIDs and a potential gut microbiota dysbiosis has been poorly explored. OBJECTIVE We aimed to determine an association between FIDs severity and dysbiosis of the intestinal microbiota in a severely malnourished patient population with AN undergoing enteral nutrition. DESIGN Faecal microbiota of AN (DSM IVr criteria) female inpatients were collected and compared to healthy controls based on 16S rRNA profiling. The severity of FIDs was evaluated in patients and healthy controls using Francis Score. RESULTS Thirty-three patients (BMI: 11,7 ± 1,5; Age: 32 ± 12) and 22 healthy controls (BMI: 21 ± 2; age: 36 ± 12) were included. A marked dysbiosis was identified in AN patients compared to healthy controls (p = 0.03). Some potentially pathogenic bacterial genera (Klebsiella, Salmonella) were more abundant in AN patients whereas, other bacterial symbionts (Eubacterium and Roseburia) involved in immune balance were significantly less abundant in patients than controls. Severity of FIDs was strongly correlated with several microbial genera (r = -0.581 for an unknown genus belonging to Peptostreptococcaceae family; r = 0.392 for Dialister, r = 0.444 for Robinsoniella and r = 0.488 for Enterococcus). Other associations between dysbiosis, clinical and biological characteristics were identified including severity of undernutrition (BMI). CONCLUSION Observed gut microbiota dysbiosis in malnourished patients with anorexia nervosa is correlated with the severity of FIDs and other metabolic disturbances, which strongly suggests an altered host-microbe symbiosis.
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Affiliation(s)
- Mouna Hanachi
- Clinical Nutrition Unit, Raymond Poincaré University Hospital (AP-HP), Garches, France; Université de Versailles, Saint-Quentin-en- Yvelines, Montigny-le-Bretonneux, France.
| | - Chaysavanh Manichanh
- Department of Gastroenterology, Vall d'Hebron Research Institute, Barcelona, Spain.
| | | | - Victoria Pascal
- Department of Gastroenterology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Florence Levenez
- MetaGenoPolis, INRA, Université Paris-Saclay, Jouy-en-Josas, France
| | - Nicole Cournède
- Clinical Nutrition Unit, Raymond Poincaré University Hospital (AP-HP), Garches, France
| | - Joël Doré
- MetaGenoPolis, INRA, Université Paris-Saclay, Jouy-en-Josas, France; MICALIS Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Jean-Claude Melchior
- Clinical Nutrition Unit, Raymond Poincaré University Hospital (AP-HP), Garches, France; Université de Versailles, Saint-Quentin-en- Yvelines, Montigny-le-Bretonneux, France
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Halland M, Pandolfino J, Barba E. Diagnosis and Treatment of Rumination Syndrome. Clin Gastroenterol Hepatol 2018; 16:1549-1555. [PMID: 29902642 DOI: 10.1016/j.cgh.2018.05.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
Abstract
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation. The disorder appears uncommon, although only limited epidemiologic data are available. Awareness of the characteristic symptoms is essential for recognizing the disorder, and thus avoiding the long delay in diagnosis, that many patients experience. Although objective testing by postprandial esophageal high-resolution impedance manometry is available in select referral centers, a clinical diagnosis can be made in most patients. The main therapy for rumination syndrome is behavioral modification with postprandial diaphragmatic breathing. This clinical practice update reviews the pathophysiology, diagnosis, and treatment of rumination syndrome. Best Practice Advice 1: Clinicians strongly should consider rumination syndrome in patients who report consistent postprandial regurgitation. Such patients often are labeled as having refractory gastroesophageal reflux or vomiting. Best Practice Advice 2: Presence of nocturnal regurgitation, dysphagia, nausea, or symptoms occurring in the absence of meals does not exclude rumination syndrome, but makes the presence of it less likely. Best Practice Advice 3: Clinicians should diagnose rumination syndrome primarily on the basis of Rome IV criteria after an appropriate medical work-up. Best Practice Advice 4: Diaphragmatic breathing with or without biofeedback is the first-line therapy in all cases of rumination syndrome. Best Practice Advice 5: Instructions for effective diaphragmatic breathing can be given by speech therapists, psychologists, gastroenterologists, and other health practitioners familiar with the technique. Best Practice Advice 6: Objective testing for rumination syndrome with postprandial high-resolution esophageal impedance manometry can be used to support the diagnosis, but expertise and lack of standardized protocols are current limitations. Best Practice Advice 7: Baclofen, at a dose of 10 mg 3 times daily, is a reasonable next step in refractory patients.
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Affiliation(s)
- Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Elizabeth Barba
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain
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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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Strigo IA, Murray SB, Simmons AN, Bernard RS, Huang JS, Kaye WH. The clinical application of fMRI data in a single-patient diagnostic conundrum: Classifying brain response to experimental pain to distinguish between gastrointestinal, depressive and eating disorder symptoms. J Clin Neurosci 2017; 45:149-153. [PMID: 28823587 DOI: 10.1016/j.jocn.2017.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022]
Abstract
Patients with eating disorders (EDs) often present with psychiatric comorbidity, and functional and/or organic gastrointestinal (GI) symptomatology. Such multidiagnostic presentations can complicate diagnostic practice and treatment delivery. Here we describe an adolescent patient who presented with mixed ED, depressive, and GI symptomatology, who had received multiple contrasting diagnoses throughout treatment. We used a novel machine learning approach to classify (i) the patient's functional brain imaging during an experimental pain paradigm, and (ii) patient self-report psychological measures, to categorize the diagnostic phenotype most closely approximated by the patient. Specifically, we found that the patient's response to pain anticipation and experience within the insula and anterior cingulate cortices, and patient self-report data, were most consistent with patients with GI pain. This work is the first to demonstrate the possibility of using imaging data, alongside supervised learning models, for purposes of single patient classification in those with ED symptomatology, where diagnostic comorbidity is common.
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Affiliation(s)
- Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Alan N Simmons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States; San Diego Veterans Affairs Medical Center, San Diego, CA, United States
| | - Rebecca S Bernard
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Jeannie S Huang
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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45
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Gabler G, Olguín P, Rodríguez A. COMPLICACIONES MÉDICAS DE LOS TRASTORNOS DE LA CONDUCTA ALIMENTARIA. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
OBJECTIVE The diagnostic criterion disturbance in the experience of the body remains a poorly understood and persistent feature of anorexia nervosa (AN). Increased sophistication in understanding the structure of the insular cortex-a neural structure that receives and integrates visceral sensations with action and meaning-may elucidate the nature of this disturbance. We explored age, weight status, illness severity, and self-reported body dissatisfaction associations with insular cortex volume. METHODS Structural magnetic resonance imaging data were collected from 21 adolescents with a history of AN and 20 age-, sex-, and body mass index-matched controls. Insular cortical volumes (bilateral anterior and posterior regions) were identified using manual tracing. RESULTS Volumes of the right posterior insula demonstrated the following: (a) a significant age by clinical status interaction (β = -0.018 [0.008]; t = 2.32, p = .02) and (b) larger volumes were associated with longer duration of illness (r = 0.48, p < .04). In contrast, smaller volumes of the right anterior insula were associated with longer duration of illness (r = -0.50, p < .03). The associations of insular volume with body dissatisfaction were of moderate effect size and also of opposite direction, but a statistical trend in right posterior (r = 0.40, p < .10 in right posterior; r = -0.49, p < .04 in right anterior). CONCLUSIONS In this exploratory study, findings of atypical structure of the right posterior insular cortex point to the importance of future work investigating the role of visceral afferent signaling in understanding disturbance in body experience in AN.
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Abstract
Individuals with eating disorders, including anorexia nervosa and bulimia nervosa, may present with a range of gastrointestinal (GI) manifestations. The oral cavity, salivary glands, GI tract, pancreas, and liver can be impacted by nutritional restrictive and binge/purging behaviors. Complications are often reversible with appropriate nutritional therapy. At times, however, the complications in these disorders may be severe, irreversible and even life threatening. Given the often covert nature of eating disorders, the practitioner must be attentive to subtle clues that may indicate their presence. Extensive diagnostic evaluations of the GI manifestations of eating disorders should be used only when nutritional rehabilitation does not remedy the problems.
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48
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Jin DC, Cao HL, Xu MQ, Wang SN, Wang YM, Yan F, Wang BM. Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome. World J Gastroenterol 2016; 22:8137-8148. [PMID: 27688655 PMCID: PMC5037082 DOI: 10.3748/wjg.v22.i36.8137] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/28/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Serotonin (5-HT) and the serotonin transporter (SERT) have earned a tremendous amount of attention regarding the pathogenesis of irritable bowel syndrome (IBS). Considering that enteric 5-HT is responsible for the secretion, motility and perception of the bowel, the involvement of altered enteric 5-HT metabolism in the pathogenesis of IBS has been elucidated. Higher 5-HT availability is commonly associated with depressed SERT mRNA in patients with IBS compared with healthy controls. The expression difference of SERT between IBS patients and healthy controls might suggest that SERT plays an essential role in IBS pathogenesis, and SERT was expected to be a novel therapeutic target for IBS. Progress in this area has begun to illuminate the complex regulatory mechanisms of SERT in the etiology of IBS. In this article, current insights regarding the regulation of SERT in IBS are provided, including aspects of SERT gene polymorphisms, microRNAs, immunity and inflammation, gut microbiota, growth factors, among others. Potential SERT-directed therapies for IBS are also described. The potential regulators of SERT are of clinical importance and are important for better understanding IBS pathophysiology and therapeutic strategies.
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Forney KJ, Buchman-Schmitt JM, Keel PK, Frank GK. The medical complications associated with purging. Int J Eat Disord 2016; 49:249-59. [PMID: 26876429 PMCID: PMC4803618 DOI: 10.1002/eat.22504] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. METHOD Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. RESULTS Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. DISCUSSION Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder.
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Affiliation(s)
- K. Jean Forney
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Guido K.W. Frank
- Department of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO
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50
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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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