Bulimia nervosa presenting as rectal purging and rectal prolapse: Case report and literature review

Guerdjikova, Anna I.; O’Melia, Anne; Riffe, Kris; Palumbo, Todd; McElroy, Susan L.

doi:10.1002/eat.20959

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…During the process of vomiting, a deep breathing precedes the actual vomiting to protect the lungs from aspiration followed by a strong contraction of the diaphragm down with all the abdominal muscles to expel the contents of the stomach [104]. This repetitive intra-abdominal pressure in addition to constipation, pelvic floor weakness and over-exercise is considered the rationale for the relationship between BN and RP [100,105,106]. As previously mentioned, other common purging methods in bulimic patients are the laxative and enema abuse detected in 36.5% and 7.9% of patients with ED, respectively [107].…”

Section: Bulimia Nervosamentioning

confidence: 99%

Eating Disorders and Gastrointestinal Diseases

et al. 2019

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Eating disorders (ED) are frequently associated with a wide range of psychiatric or somatic comorbidities. The most relevant ED are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED). Patients with ED exhibit both upper and lower gastrointestinal (GI) symptoms. Evidence of alterations throughout the GI tract in ED will be analyzed given the role of the GI tract in food intake and its regulation. It remains a matter of debate whether GI disorders are inherent manifestations of ED or the results of malnutrition occurring from ED. Moreover, recent clinical studies have highlighted the growing role of intestinal microbiota in the pathogenesis of ED, making it possible to hypothesize a modulation of intestinal microbiota as a co-adjuvant to standard therapy. The aim of this review is to analyze the link between ED and GI diseases and to present, where known, the potential key factors underlying these conditions. Conclusions: The presence of GI disorders should be investigated in patients with ED. Screening for ED should also be encouraged in individuals seeking treatment for unexplained GI complaints to better address therapeutic issues that surround these difficult medical conditions. Nutrients 2019, 11, 3038 3 of 17 ED can be associated with anxiety or mood disorders; insomnia; as well as somatic complications such as cardiac alterations, hormonal imbalances and also a wide range of gastrointestinal (GI) symptoms [3].Prevalence estimate of lifetime AN is 0.8% [4]. The overall incidence rate of AN is around 7 per 100,000 persons; however, it is higher in 15-19 year old girls reaching 109.2 cases per 100,000. The incidence is increasing in Italy and other Western countries probably due to earlier diagnosis or earlier onset [5,6].The prevalence of BN is 0.28% [4]. The highest incidence rate of BN is 300 per 100,000 persons in women aged between 16 and 20 [7], although the age at onset is decreasing [5].BED are described in 0.85% of the population [4,8] and are frequently associated with medical comorbidities, especially obesity and its complications such as Type II diabetes mellitus, hypertension, and dyslipidemia [9]. Furthermore, BED may occur in a subset ranging from 27% to 47% in severely obese persons undergoing bariatric surgery [10].The previous edition of DSM (DSM-IV) [11], classified as "Eating Disorders Not Otherwise Specified (EDNOS)", is the ED that does not satisfy all the diagnostic criteria for AN or BN. Previously, EDNOS contained a huge and varied group of individuals and was the most commonly diagnosed ED. However, the DSM-V revised this ED type and called it "Other Specified Feeding or Eating Disorder" (OSFED). Moreover, the DSM-V introduced the definition of Avoidant/restrictive food intake disorder (ARFID) that was distinct from AN and BN in that there is no body image disturbance [2].The first description of AN in the 19th century revealed that the sufferers' reasons for self-starvation generally were strictly connected to inappetence, feelings of fullness and abdominal ...

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Section: Bulimia Nervosamentioning

confidence: 99%

Eating Disorders and Gastrointestinal Diseases

et al. 2019

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“…In one study from 2013 researchers reported that it is highly probable that GI symptoms frequently reported by inpatients with EDs are representative of FGIDs defined by the Rome‐II criteria (Abraham & Kellow, 2013). Unsurprisingly, various studies reported on IBS and symptoms of IBS in AN, BN and EDNOS (Abraham & Kellow, 2011; Boyd et al., 2005; Dejong et al., 2011; Guerdjikova et al., 2012; Perkins et al., 2005; Santonicola et al., 2012; Wang et al., 2014). A few studies focused on FGID symptoms in patients with BED (Cremonini et al., 2009; Crowell et al., 1994; Javaras et al., 2008; Levy et al., 2005; Santonicola et al., 2013).…”

Section: Resultsmentioning

confidence: 99%

Irritable bowel syndrome and functional dyspepsia in patients with eating disorders ‐ a systematic review

Hanel

Schalla

Stengel

2021

Euro Eating Disorders Rev

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Objectives: The prevalence of eating disorders is rising worldwide. The low body weight in anorexia nervosa as well as the increase in body mass index due to binge eating disorder are contributing to a strikingly high morbidity and mortality. In a similar pattern, the prevalence and burden of the disease of functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome is increasing. As gastrointestinal complaints are commonly reported by patients with eating disorders, the question arose whether there is a relationship between eating disorders and functional gastrointestinal disorders.Methods: To address the need to better understand the interplay between eating disorders and functional gastrointestinal disorders as well as factors that might influence this connection, the data bases Medline, Web of Science and Embase were systematically searched.Results: After removal of duplicates the search yielded 388 studies which were screened manually. As a result, 36 publications were selected for inclusion in this systematic review. Conclusion:The occurrence of functional gastrointestinal disorders like irritable bowel syndrome and functional dyspepsia in patients with eating disorders is considerably high and often associated with psychological, hormonal and functional alterations. In the future, further research addressing the underlying mechanisms accounting for this relationship is required.

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“…In 1997 Malik et al published a case series on seven patients with BN and hypothesized that chronically high intra-abdominal pressure associated with vomiting and straining, prolonged gut transit time, and constipation contributed to the rectal prolapse observed [5]. Guerdjikova and colleagues published a case history of another BN patient that experienced rectal prolapse although in this case, rectal purging (repeated finger evacuation of feces in the rectum) was suspected to be the primary contributor [6]. In 2001 Dreznik et al published a case series describing three young women with AN and rectal prolapse [7].…”

Section: Resultsmentioning

confidence: 99%

Rectal prolapse associated with anorexia nervosa: a case report and review of the literature

Mitchell

Norris

2013

J Eat Disord

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Anorexia nervosa is one of a few mental health diagnoses that affects every organ system. Patients with AN often present with multiple secondary effects of starvation at the time of first assessment, including gastrointestinal (GI) complaints. In extreme cases, severe GI complications such as rectal prolapse may be encountered as a consequence of the illness although formal studies investigating the frequency of such occurrences are lacking. We present the case of a 16 year old female previously diagnosed with anorexia nervosa that developed a rectal prolapse as a consequence of her disease as well as a detailed literature review investigating the frequency and prevalence of such occurrences in this population.

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Bulimia nervosa presenting as rectal purging and rectal prolapse: Case report and literature review

Cited by 15 publications

References 19 publications

Eating Disorders and Gastrointestinal Diseases

Eating Disorders and Gastrointestinal Diseases

Irritable bowel syndrome and functional dyspepsia in patients with eating disorders ‐ a systematic review

Rectal prolapse associated with anorexia nervosa: a case report and review of the literature

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