Primary anorexia nervosa: Gastric emptying and antral motor activity in 53 patients

Abstract

In 53 consecutive patients with primary anorexia nervosa, gastric emptying of a semisolid meal was significantly slower than in 24 healthy subjects. Slow emptying tended to be associated with low serum potassium, low body weight, and long illness duration. Antral contraction amplitudes were lower than in healthy subjects and failed to increase postcibally, whereas contraction frequency and rhythmicity seemed unaffected. After the gastric prokinetic agent, cisapride, 8 mg intravenously administered double‐blind, emptying was significantly faster than after placebo. The recognition of impaired gastric motility may be important in the management of anorexia nervosa.

Normal gastric antral myoelectrical activity in early onset anorexia nervosa.

“…'6 In experimental animals the prodromal (preejection) phase of the emetic reflex is characterised, among the other vagally mediated autonomic outputs, by suppression of the gastric antral pacemaker and the induction of electrical dysrhythmias.17 Electrical dysrhythmias are associated with loss of electromechanical coupling in the antrum, resulting in impaired antral contractility and delayed gastric emptying. '8 19 The correlation between these electromechanical abnormalities and symptoms of early satiety, postprandial discomfort, bloating, nausea, and vomiting has been clearly established in a number of clinical disorders.20-26 Such symptoms are commonly reported in adults with anorexia nervosa.2 Studies of foregut motor function and gastric emptying in adults with anorexia and bulimia nervosa have consistently shown that the amplitude of gastric antral contractions is impaired during fasting and after feeding, and that gastric emptying is often significantly delayed in patients with anorexia nervosa.34 [27][28][29] Therefore it has been suggested that these foregut motility disorders may contribute to or perpetuate the eating disorder by inducing nausea and other aversive food related sensations, by causing bloating and thereby exacerbating the patient's fear of fatness and distorted body image.4 The correlation between gastrointestinal symptoms and disordered gastric emptying was not always clear, however.30 31 Although there is general agreement about the frequency of gastrointestinal dysmotility in adult anorexia nervosa, much less is known about the causes of the dysmotility and uncertainty still exists as to whether this is a primary, and therefore pathogenetically relevant, or secondary phenomenon. It seems likely from the present and previous studies that it is a secondary phenomenon, possibly related to the degree of malnutrition.…”

Anorexia Nervosa and the Use of Total Parenteral Nutrition Refeeding

“…As opposed to bulimics who vomit excessively or abuse laxatives, anorectics have less severe gastrointestinal problems. Gastrointestinal transit is known to be prolonged in patients with anorexia, affecting up to 80% of patients [38]. Alterations in antral motility and gastric atrophy are thought to be responsible for these problems.…”

Anaesthetic implications of anorexia nervosa

“…The reason for this is poorly understood, although increased gastric emptying times are associated with profound weight loss and severe dietary restriction (interestingly, emptying times are decreased as renutrition programmes are completed), and autonomic dysfunction has also been implicated as a cause [20]. Gastric dilatation can occur and, if acute, may lead to gastric infarction or perforation [21].…”