Association between gastrointestinal complaints and psychopathology in patients with anorexia nervosa

Objective Gastrointestinal (GI) disturbances are a frequent and burdensome experience for patients with anorexia nervosa (AN). How GI symptoms respond to current interventions is not well characterized, yet is critical to facilitate treatment success, and to inform the development of new treatments for AN. Therefore, the aim of this systematic review was to identify which treatments are effective in improving GI symptoms in patients with AN. Method A systematic search for studies of AN treatments measuring GI symptoms pre‐ and post‐treatment was conducted in May 2020 (PROSPERO ID: CRD42020181328). After removal of duplicates, title and abstracts of 3,370 studies were screened. Methodological quality was assessed using National Institute of Health Quality Assessment Tool. Results Following full‐text screening, 13 studies (12 observational studies and 1 randomized double‐blind placebo‐controlled trial) with 401 participants met eligibility criteria and were included. All observational studies included a component of nutritional rehabilitation, with half (n = 6) involving concurrent psychological treatment. The randomized controlled trial reported a drug therapy. Eleven studies reported an improvement in all (n = 6) or at least one (n = 5) patient‐reported GI symptom following treatment. Two studies reported no change. Methodological quality was fair or poor across all studies. Discussion This is the first systematic review to synthesize available evidence on the trajectory of patient‐reported GI symptoms from commencement to end of treatment for AN. The results suggest that most studies showed improvement in one or more GI symptom in response to current treatments. Future therapeutic approaches should consider GI symptoms within their design for optimal treatment adherence and outcomes.

Section: Discussionmentioning

confidence: 99%

Gastrointestinal symptoms following treatment for anorexia nervosa: A systematic literature review

West

McMaster

Staudacher

et al. 2021

“…Boyd et al (2005) found somatization and anxiety to predict development of individual FGIDs and neuroticism to predict the presence of three or more FGIDs in those with AN. Similarly, Kessler et al (2020) found that the severity of functional GI pain correlated with higher somatization scores in AN. Salvioli et al (2013) found hypochondriasis to predict likelihood of functional GI complaints as well as lack of improvement in symptoms while Ochi et al (2008) found perfectionism traits in AN to correlate with GI symptoms and functional dyspepsia.…”

Section: Resultsmentioning

confidence: 83%

“…Studies suggest a prevalence of FGIDs, prior to ED treatment, ranging from 56 to 97%, depending on the population examined (Boyd et al, 2010; Perez et al, 2013). BMI does not seem to correlate with self‐reported functional GI symptoms prior to weight restoration (Kessler et al, 2020; Perkins et al, 2005; Porcelli et al, 1998; Salvioli et al, 2013), although one study did show that IBS, one of the FGIDs associated with abdominal pain and changes in stool habits, was less prevalent at a normal BMI (defined as 20–25 kg/m 2 ) compared to those whom were underweight; this study did not differentiate individuals suffering from AN, BN, and EDNOS (Abraham & Kellow, 2011). Similarly, Santonicola et al (2012) found a significantly increased frequency of postprandial distress syndrome in underweight patients with AN compared to healthy controls.…”

Section: Resultsmentioning

confidence: 99%

“…A high percentage of individuals with EDs indeed meet criteria for an FGID (Boyd et al, 2010). In general, BMI and the GI physiologic changes do not seem to correlate with the presence of FGIDs, but psychological distress seems to better correlate with reported GI symptoms (Kessler et al, 2020). Furthermore, weight restoration may improve the symptoms of FGIDs, although FGIDs remain problematic and continue to contribute toward disordered eating, with ongoing psychological distress seemingly the largest predictor for development and maintenance of an FGID (Boyd et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

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The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Gibson

Watters

Mehler

2021

Objective Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating. Methods Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review. Results A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. Discussion Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.

“…In addition, patients with eating disorders are about three times more likely than controls to seek treatment for GI problems (Winstead & Willard, 2006). Furthermore, GI problems have been found to be associated with somatization in patients with AN (Kessler et al, 2020). However, the relationship between DGBI and eating disorders is complex and potentially bidirectional.…”

Section: Introductionmentioning

confidence: 99%

Evaluating disorders of gut‐brain interaction in eating disorders

Wiklund

Rania

Kuja‐Halkola

et al. 2021

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.