Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design

Abstract

Background Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathophysiology of purging disorder (PD). Methods Women (N = 95) recruited from the community meeting criteria for DSM-5 BN who purged (n = 26), BN with nonpurging compensatory behaviors (n = 18), PD (n = 25), or healthy control women (n = 26) completed assessments of gastric emptying, gut peptides, and subjective responses over the course of a standardized test meal under two conditions administered in a double-blind, crossover sequence: placebo and 10 mg of metoclopramide. Results Delayed gastric emptying was associated with purging with no main or moderating effects of binge eating in the placebo condition. Medication eliminated group differences in gastric emptying but did not alter group differences in reported gastrointestinal distress. Exploratory analyses revealed that medication caused increased postprandial PYY release, which predicted elevated gastrointestinal distress. Conclusions Delayed gastric emptying demonstrates a specific association with purging behaviors. However, correcting disruptions in gastric emptying may exacerbate disruptions in gut peptide responses specifically linked to the presence of purging after normal amounts of food.

Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long‐term follow‐up

“…In addition, purging disorder requires recurrent purging whereas bulimia nervosa may include non-purging compensatory behaviors, such as fasting or excessive exercise. Concurrent data support purging disorder as distinct from bulimia nervosa on indicators of comorbidity (Keel et al, 2005(Keel et al, , 2007(Keel et al, , 2008Koch et al, 2013;Smith et al, 2017) and subjective and physiological response to eating (Dossat et al, 2015;Keel et al, 2007Keel et al, , 2018Keel et al, , 2021Maske et al, 2020). The inclusion of purging disorder as an other specified feeding or eating disorder (OSFED) in DSM-5 reflected limited information regarding the clinical utility of identifying purging disorder as a full-threshold DSM-5 eating disorder that is distinct from established DSM-5 eating disorders.…”

Examining negative urgency as a predictor of eating disorder maintenance in purging syndromes

“…Baseline data come from a prior study examining psychological and physiological correlates of binge eating (Davis et al, 2020; Keel, Eckel, et al, 2018, Keel, Haedt‐Matt, et al, 2018; Keel et al, 2023). At baseline, women ages 18–45 were recruited from the community and university via emails and flyers in Iowa City, IA and Tallahassee, FL.…”

“…At baseline, women ages 18–45 were recruited from the community and university via emails and flyers in Iowa City, IA and Tallahassee, FL. Sixty‐eight women who engaged in recurrent self‐induced vomiting (36 BN; 32 PD) completed diagnostic interviews and a questionnaire battery at baseline (Davis et al, 2020; Keel, Eckel, et al, 2018, Keel, Haedt‐Matt, et al, 2018; Keel et al, 2023) and were invited to participate in a larger follow‐up study (Forney et al, 2021, 2022). The baseline parent study required a body mass index (BMI) between 18 and 26.5 kg/m 2 , recurrent self‐induced vomiting (on average at least once weekly), and meeting criteria for DSM‐5 BN or research criteria for PD.…”

“…Sixty-eight women who engaged in recurrent self-induced vomiting (36 BN; 32 PD) completed diagnostic interviews and a questionnaire battery at baseline (Davis et al, 2020;Keel, Eckel, et al, 2018Keel et al, 2023) and were invited to participate in a larger follow-up study (Forney et al, 2021(Forney et al, , 2022.…”

Piezo1 in Digestive System Function and Dysfunction

“…Consistently, activation of Piezo1 in pharynx and anterior gut by food intake weakens pharyngeal pumping, pharyngeal gland activation and decreases appetite [ 48 , 113 ]. In fact, the disorder of mechanical signal such as delayed gastric emptying is associated with purging behaviors in clinical experiment [ 114 ]. We don’t know if Piezo mediated this reaction.…”