The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide

Staller, Kyle; Abber, Sophie R.; Murray, Helen Burton

doi:10.1016/s2468-1253(22)00351-x

Cited by 9 publications

(12 citation statements)

References 113 publications

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“…31,32 In addition to avoidance of exclusion diets, other treatment strategies, such as cathartic laxative agents, may not be appropriate for patients with active eating disorders. 30,33 This seems to be especially true for patients who are underweight at GI consult, as our data suggest that these patients were 87% less likely to be in remission.…”

Section: Discussionmentioning

confidence: 75%

“…Addressing GI symptoms in conjunction with eating disorder-specific therapy may help to increase treatment success, as ongoing symptoms may reinforce maladaptive behaviors. 30 This study has several limitations due to its retrospective de- and also does not adequately reflect the demographics of eating disorders, with some studies reporting that males make up 25-33% of eating disorder patients. 34 By retrospectively evaluating GI encounter-associated diagnoses rather than patient-reported symptoms, it is possible that we did not gain a full understanding of the temporal relationship between GI symptoms and eating disorders-some GI symptoms may have preceded the GI encounter, or even the eating disorder itself.…”

Section: Discussionmentioning

confidence: 96%

“…This finding underscores the importance of eating disorder screening among GI clinicians, which is rarely part of a standard GI intake. 14 Asking about eating disorder symptoms in a non-judgmental way can foster open communication about restricted eating practices and other behaviors, 30 and patients with active eating disorder symptoms may benefit from understanding how their GI symptoms impact their eating behaviors and may warrant different GI treatment strategies. 31,32 In addition to avoidance of exclusion diets, other treatment strategies, such as cathartic laxative agents, may not be appropriate for patients with active eating disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Asking about eating disorder symptoms in a non‐judgmental way can foster open communication about restricted eating practices and other behaviors, 30 and patients with active eating disorder symptoms may benefit from understanding how their GI symptoms impact their eating behaviors and may warrant different GI treatment strategies 31,32 . In addition to avoidance of exclusion diets, other treatment strategies, such as cathartic laxative agents, may not be appropriate for patients with active eating disorders 30,33 . This seems to be especially true for patients who are underweight at GI consult, as our data suggest that these patients were 87% less likely to be in remission.…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010–2020

Almeida,

Atkins,

Garcia‐Fischer

et al. 2024

Neurogastroenterology Motil

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Background and AimsGastrointestinal (GI) disorders are common in patients with eating disorders. However, the temporal relationship between GI and eating disorder symptoms has not been explored. We aimed to evaluate GI disorders among patients with eating disorders, their relative timing, and the relationship between GI diagnoses and eating disorder remission.MethodsWe conducted a retrospective analysis of patients with an eating disorder diagnosis who had a GI encounter from 2010 to 2020. GI diagnoses and timing of eating disorder onset were abstracted from chart review. Coders applied DSM‐5 criteria for eating disorders at the time of GI consult to determine eating disorder remission status.ResultsOf 344 patients with an eating disorder diagnosis and GI consult, the majority (255/344, 74.2%) were diagnosed with an eating disorder prior to GI consult (preexisting eating disorder). GI diagnoses categorized as functional/motility disorders were most common among the cohort (57.3%), particularly in those with preexisting eating disorders (62.5%). 113 (44.3%) patients with preexisting eating disorders were not in remission at GI consult, which was associated with being underweight (OR 0.13, 95% CI 0.04–0.46, p < 0.001) and increasing number of GI diagnoses (OR 0.47 per diagnosis, 95% CI 0.26–0.85, p = 0.01).ConclusionsEating disorder symptoms precede GI consult for most patients, particularly in functional/motility disorders. As almost half of eating disorder patients are not in remission at GI consult. GI providers have an important role in screening for eating disorders. Further prospective research is needed to understand the complex relationship between eating disorders and GI symptoms.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010–2020

Almeida,

Atkins,

Garcia‐Fischer

et al. 2024

Neurogastroenterology Motil

Self Cite

View full text Add to dashboard Cite

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“…While our study included a well‐validated measure of ED symptoms, 42 our study lacked inclusion of a measure specific to avoidant/restrictive food intake disorder (ARFID), an ED with high comorbidity in DGBI 43,44 . It is possible that the Oral Control subscale may capture some ARFID symptoms, as shown in studies with children and adolescents 45,46 .…”

Section: Discussionmentioning

confidence: 99%

Latent profile analysis reveals the central role of psychological symptoms in driving disease severity in chronic constipation

Abber,

Buchanan,

Clukey

et al. 2024

Neurogastroenterology Motil

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BackgroundChronic constipation (CC) is defined by symptom criteria reflecting heterogenous physiology. However, many patients with CC have significant psychological comorbidities—an alternative definition using a biopsychosocial classification model could be warranted to inform future treatments. We sought to: (1) empirically derive psychological symptom profiles of patients with CC using latent profile analysis and (2) validate these profiles by comparing them on symptom severity, GI‐specific anxiety, body mass index (BMI), and anorectal manometry findings.MethodsParticipants included adults presenting for anorectal manometry for CC (N = 468, 82% female, Mage = 47). Depression/anxiety symptoms and eating disorder (ED) symptoms (EAT‐26) were used as indicators (i.e., variables used to derive profiles) representing unique psychological constructs. Constipation symptoms, GI‐specific anxiety, BMI, and anorectal manometry results were used as validators (i.e., variables used to examine the clinical utility of the resulting profiles).Key ResultsA 5‐profile solution provided the best statistical fit, comprising the following latent profiles (LPs): LP1 termed “high dieting, low bulimia;” LP2 termed “high ED symptoms;” LP3 termed “moderate ED symptoms;” LP4 termed “high anxiety and depression, low ED symptoms;” and LP5 termed “low psychological symptoms.” The low psychological symptom profile (61% of the sample) had lower abdominal and overall constipation severity and lower GI‐specific anxiety compared to the four profiles characterized by higher psychological symptoms (of any type). Profiles did not significantly differ on BMI or anorectal manometry results.Conclusions and InferencesProfiles with high psychological symptoms had increased constipation symptom severity and GI‐specific anxiety in adults with CC. Future research should test whether these profiles predict differential treatment outcomes.

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Shared genetic influences between eating disorders and gastrointestinal disease in a large, population-based sample of adult women and men

Pascoe,

Mikhail,

Burt

et al. 2023

Psychol. Med.

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Background Some preliminary research suggests higher rates of gastrointestinal disease in individuals with eating disorders (EDs). However, research is limited, and it remains unknown what etiologic factors account for observed associations. This was the first study to examine how EDs and dimensional ED symptoms (e.g. body dissatisfaction, binge eating) are phenotypically and etiologically associated with gastrointestinal disease in a large, population-based twin sample. Methods Adult female (N = 2980) and male (N = 2903) twins from the Michigan State University Twin Registry reported whether they had a lifetime ED (anorexia nervosa, bulimia nervosa, or binge-eating disorder) and completed a measure of dimensional ED symptoms. We coded the presence/absence of lifetime gastrointestinal disease (e.g. inflammatory bowel disease) based on responses to questions regarding chronic illnesses and medications. We first examined whether twins with gastrointestinal disease had higher rates of EDs and ED symptoms, then used correlated factors twin models to investigate genetic and environmental contributions to the overlap between disorders. Results Twins with gastrointestinal disease had significantly greater dimensional ED symptoms (β = 0.21, p < 0.001) and odds of a lifetime ED (OR 2.90, p = 0.001), regardless of sex. Shared genetic factors fully accounted for the overlap between disorders, with no significant sex differences in etiologic associations. Conclusions Comorbidity between EDs and gastrointestinal disease may be explained by overlap in genetic influences, potentially including inflammatory genes implicated in both types of disorders. Screening for gastrointestinal disease in people with EDs, and EDs in those with gastrointestinal disease, is warranted.

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The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide

Cited by 9 publications

References 113 publications

Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010–2020

Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010–2020

Latent profile analysis reveals the central role of psychological symptoms in driving disease severity in chronic constipation

Shared genetic influences between eating disorders and gastrointestinal disease in a large, population-based sample of adult women and men

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