Effect of Nutritional Rehabilitation on Gastric Motility and Somatization in Adolescents with Anorexia

Abstract

Objective To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation. Study design Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms–Rome III version. All testing was repeated 3–4 months later. Results Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003). Conclusion Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.

Relationship of body weight with gastrointestinal motor and sensory function: studies in anorexia nervosa and obesity

“…These findings are consistent with previous studies that often reported delayed gastric emptying for AN, but similar emptying in OB compared to HC [16–19, 25, 27–31, 50–52]. Interestingly, no difference in antral contraction frequency was present between groups.…”

“…It should be noted that AN2 patients were still underweight (average BMI of 18.1 kg/m 2 ) and that this effect might have been more distinct with more pronounced increase in BMI. This finding is consistent with previous studies in AN with comparable follow-up time and BMI at follow-up [25, 27, 29, 50, 72]. These investigations found accelerated gastric emptying particularly in the restrictive type of anorexia nervosa, while gastric emptying in the purging type remained unchanged (here 9 of 12 patients that gained weight were classified as restrictive type AN at study entry).…”

Are children with chronic illnesses requiring dietary therapy at risk for disordered eating or eating disorders? A systematic review

“…Boyd, Abraham, and Kellow () and Boyd, Abraham, and Kellow () studies have found that 97–98% of inpatients with an ED had a gastrointestinal disorder, 53% had three or more gastrointestinal disorders, and 77% continued to have a gastrointestinal disorder at 12‐month follow‐up (Boyd et al, ). Children with AN specifically have a high rate of gastrointestinal disorders or symptoms (75–79%) compared to healthy children and the severity of AN is positively associated with gastrointestinal symptoms (Lee, Ng, Kwok, Thomas, & Becker, ; Perez, Coley, Crandall, Di Lorenzo, & Bravender, ). Irritable bowel syndrome presents as the most common gastrointestinal disorder in children with AN (Perez et al, ).…”

Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents

“…This measure of anxiety symptoms has well-established psychometric properties, 24 and has been used with children and adolescents with chronic illnesses. 25 …”