A serial study of gastric emptying in anorexia nervosa and bulimia

Abstract

To determine the natural history of delayed gastric emptying of solid foods in anorexia nervosa (AN), gastric emptying was assessed by scintigraphy in 20 consecutive inpatients; eight had restrictive AN, ten had both AN and bulimia nervosa (BN), and two BN alone. Initial gastric half-emptying time (HET) exceeded 110 min (the upper limit of normal for the laboratory) in 16; their body mass index ranged from 11.7 to 18.1. HET showed a significant negative correlation with body mass (r = 0.71; p less than 0.001) but not age, duration of illness or use of psychotropic medication. Fourteen patients with prolonged emptying were retested; HET improved in nine of 12 retested at one month (p = 0.0005) but none showed a change in the lag phase of emptying. All four patients retested a further one to two months later achieved a HET less than 110 min. Fourteen patients reached a body mass index of 16.3 during treatment and HET improved to better than 110 min in all but one of these. However, normalisation occurred while body mass was still subnormal (less than 20.3) and with amenorrhea still present. This study shows that delayed gastric emptying in AN improves quite rapidly as feeding recommences; thus the motility disturbance is secondary to restriction in food intake and is not fundamental to the disorder.

A controlled trial of cisapride in anorexia nervosa

“…One study has reported a rapid improvement over the first few weeks of refeeding (Robinson et al, 1988) while others have reported a slower improvement (Szmukler et al, 1990) or little change (Abell et al, 1987). The results of this study support the latter.…”

“…Serial studies have generally shown an improvement in gastric emptying with refeeding (Rigaud et al, 1988;Szmukler et al, 1990) although exceptions have been noted (Dubois et al, 1981;Abell et al, 1987). The rate of improvement varies, one study finding normal emptying after only 2 weeks (although this was not a serial study; Robinson et al, 1988), while we found that 50% of patients failed to normalize after a month (Szmukler et al, 1990).…”

“…The rate of improvement varies, one study finding normal emptying after only 2 weeks (although this was not a serial study; Robinson et al, 1988), while we found that 50% of patients failed to normalize after a month (Szmukler et al, 1990).…”

“…& Wald, 1990;Szmukler, Young, Lichtenstein, & Andrews, 1990). The delay in emptying is particularly noted for solids and hypertonic liquids (Domstad et al, 1987).…”

Normal gastric antral myoelectrical activity in early onset anorexia nervosa.

“…It seems likely from the present and previous studies that it is a secondary phenomenon, possibly related to the degree of malnutrition. Two studies clearly indicate that delayed gastric emptying, though common in patients with anorexia nervosa, promptly reverts to normal with the completion of a renutritional programme.32 33 The feeding pattern also seems to play a part, as shown by another study in which gastric emptying of a caloric meal was delayed in patients with anorexia nervosa who were selecting their own restrictive diet, whereas it was normal in patients with anorexia nervosa who were receiving adequate nutrition.34 Furthermore, all gastrointestinal symptoms reported by patients improve significantly with refeeding. 32 35 These findings are in agreement with the well known observation that gastrointestinal function is disturbed during starvation and returns to normal when normal nutritional status is re-established.…”