Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment

Abstract

BackgroundIn patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN.MethodsIn weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models.ResultsAbdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation.ConclusionsInforming patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.

Case report: Carbohydrate malabsorption in inpatients with anorexia nervosa

“…The severity level of ED reflected in the EDE-Q ( 22 ) was below levels compared with previous studies on patients with EDs ( 22 , 31 ) with scores of 4 or higher (current mean EDE-Q score: 3.28). The assessment of attitudinal and behavioral features corresponding to AN or bulimia nervosa by EDI-2 ( 23 ) was higher than levels reported before in patients with AN ( 7 , 32 ) (mean EDI-2 score scaled to 100: 53.9). For the assessment of body image, both subscales of the questionnaire FKB-20 were considered.…”

“…The body image score (mean: 35.7) was higher in comparison to the one observed in the mentioned anorexic group and patients with a somatoform disorder ( 33 ). Anxiety was reported as mild (mean GAD-7 score: 7.1) ( 25 ), and therefore higher compared with the general population ( 34 ) but lower than previously reported in patients with AN ( 7 ). Depressive symptoms (PHQ-9, score 0–4: minimal, score 5–9: mild, score 10–14: moderate, score 15–19: moderately severe, scale 20–27: severe) ( 35 ) were reported to be moderate in the current sample (mean PHQ-9 score: 11.3) consistent with a previous study on patients with AN ( 7 ).…”

“…The total scores were used for the evaluation of all questionnaires. Only in the case of the GSRS, the subscales and an AN-specific total score (consisting of the GSRS subscales, which—as the study by Riedlinger et al ( 7 ) showed—are most frequently pathological in patients with AN at the beginning of therapy: abdominal pain, indigestion, and constipation) were additionally calculated.…”

“…More than 90% of the patients with AN report the presence of gastrointestinal (GI) complaints, such as postprandial fullness ( 5 ), bloating, abdominal pain, or diarrhea ( 6 , 7 ). Furthermore, reduced intestinal motility and/or constipation are frequently reported ( 8 ).…”

Carbohydrate malabsorption in anorexia nervosa: a systematic review

“…In the two analyzed studies GI complaints (abdominal pain, nausea, bloating and flatulence) in patients with EDs were reported related to the ingestion of fructose(sorbitol) or lactose [27,28]. Aside from constipation as a frequently reported symptom in patients with AN [29], lactose intolerance was likewise named as the most prevalent coexisting GI condition occurring in young girls with restricted eating behavior [28]. The study by Friesen et al [27] described an increase of the above-mentioned complaints in patients with a BMI ≤ 17.5 kg/m 2 , therefore more common in AN, after ingestion of a fructose-sorbitol solution.…”