Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis

Abstract

Background: Eating disorders (ED) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are often accompanied by a variety of psychological and physical comorbidities. Gastrointestinal (GI) symptoms are a classical feature in most patients with ED. The heterogeneity of studies on this topic is high, making it difficult to have a clear overview. The aim of this systematic review is therefore to provide an overview of subjectively and objectively measured differences and changes in the GI tract in patients with EDs, along with the occurrence of GI complications. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar to find all relevant studies examining GI problems in AN, BN, and BED. Quantitative analyses were performed for objective GI physiology measures where applicable. Results: The review differentiated between ED types and also between studies that report GI outcomes of ED in (i) human studies with an ED diagnosis excluding case reports that provide an overview of GI problems in ED and (ii) case reports with an ED diagnosis describing rare GI complications in ED. GI symptoms and impaired gastric transit times were frequent features of EDs with specific differences found for the ED types. During the time course of treatment, GI symptoms changed and/or improved but not completely. GI complications extended the range of GI problems observed, including a variety of serious complications such as gastric dilatation. Conclusions: Problems of the GI tract are frequent in patients with ED and it is likely that they complicate therapy, especially in patients with AN.

Gastrointestinal symptoms following treatment for anorexia nervosa: A systematic literature review

“…Alternatively, GI symptoms may be present but have an underlying abnormal physiological cause, such as impaired gastric motility (Chandran, Prakrithi, Mathur, Kishor, & Rao, 2018; Drossman, 2016). Patients with AN may experience both functional and organic GI symptoms (Riedlinger et al, 2020); however, these are not necessarily related to one another (Gronlund et al, 2018), and can exist in isolation, or combination.…”

“…Upper and lower GI symptoms are often reported by AN patients, with abdominal distension and postprandial fullness being the most common upper GI symptoms (Salvioli et al, 2013), and constipation the most common lower GI symptom (Chiarioni et al, 2000; Riedlinger et al, 2020; Salvioli et al, 2013; Sileri et al, 2014). The relationship between the development of GI symptoms and eating disorder (ED) diagnosis is not well defined and varies between individuals (Zipfel et al, 2006).…”

The Phenome-wide Consequences of Anorexia Nervosa Genes

“…By understanding the associations of AN gene expression with symptomatology, prodromal or subthreshold disease states, we may gain insights into the biology of the disease, and perhaps identify therapeutic targets and opportunities for clinical interventions. For example, if gastrointestinal complaints are truly the consequence of aberrant AN gene expression, and contribute to disordered eating due to gastrointestinal distress, treatment of those symptoms may help alleviate other AN symptoms or prevent development of later AN(92,93). An understanding of the clinical consequences of AN gene expression can further augment the definition of AN, and could allow clinicians to more broadly identify individuals at greater risk of AN, or those who present with symptom constellations that do not yet meet the established diagnostic threshold.…”

ANZAED practice and training standards for dietitians providing eating disorder treatment

“…gluten-free, food allergy −/intolerance-related, vegan) [27,28] or medically prescribed restrictive diet (e.g. due to type 1 diabetes, coeliac disease [29][30][31] or low 'FODMAP' diet due to irritable bowel syndrome [32]); (e) post-bariatric surgery [33]; (f) presenting with unspecified gastrointestinal symptoms such as constipation or abdominal pain [34,35], or with a diagnosis of irritable bowel syndrome [32]; (g) presenting with physical symptoms or electrolyte disturbance that could be attributed to starvation/malnutrition or purging behaviour [36]; (h) being a restrained eater [37], or restricting energy and nutritional intake [38]; (i) having a concurrent mental health concern [22,39]; and (j) elite athletes who participate in individual sports or that require meeting a weight criterion (e.g. lightweight rowers, jockeys, martial arts practitioners, boxers, dancers, gymnasts) [40].…”

“…Particular attention should be given to the individual's beliefs about food, any dietary rules, dieting behaviour, food avoidance, attempts to reduce weight and weight history [2]. Additionally enquiring about and being aware of physical and psychological signs and symptoms of starvation such as preoccupation with food [50], hypothermia [50], bradycardia [51], postural hypotension [51], GI dysfunction [34], appetite disturbance [52], social isolation [50], depression [53] and hypoglycaemia [54] is useful. Dietitians specialising in eating disorder treatment should also ask about the frequency and triggers for eating disorder behaviours such as binge eating, and compensatory behaviours such as vomiting, laxative use, and excessive exercise [2].…”