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Bulimia nervosa is a health problem of increasing magnitude that is estimated to affect 2-5% of the American adolescent and young adult female population. Because of the magnitude of this clinical problem and because of the importance of the upper gastrointestinal tract in its expression, a intradepartmental program of health care for patients affected with the disease was initiated. Eleven consecutive symptomatic bulimic individuals have been evaluated jointly by the gastroenterology and the psychiatry departments of the University of Pittsburgh. Five of these 11 individuals were found to have clinically important upper gastrointestinal pathology including ulcerative esophagitis, erosive gastritis, duodenal ulcer, and delayed gastric emptying. These gastrointestinal conditions could have been either a result of or have contributed to the symptomatology of these five patients. These data suggest that bulimic subjects have clinically important gastroenterological disease processes that require specific diagnosis and treatment independent of the psychiatric treatment provided for the bulimic condition.

A case of a 20-yr-old female with possible "alcoholic hepatitis" and a mixed micro/macronodular cirrhosis occurring in association with overt bulimia and a history of anorexia nervosa, but without any objective evidence of either alcoholism or alcohol abuse, is reported. The possible factors that may have contributed, either alone or in combination, to produce this unusual occurrence are discussed.

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