Gastrointestinal alterations in anorexia nervosa — A systematic review

Abstract

Objective: Anorexia nervosa (AN) is an eating disorder characterized by body schema disruptions, underweight (>15% reduction of the ideal body weight or a body mass index <17.5 kg/m 2 ), self-induced weight reduction, and endocrine impairments. The three latter features greatly impact on most physiological functions including the cardiovascular, skeletal, reproductive, and the gastrointestinal system, which results in an increased mortality rate in affected individuals. Especially, gastrointestinal alterations are described as particularly bothersome by patients.Methods: To address the need for a better understanding of the interplay between AN and the gastrointestinal (GI) tract, a systematic data search in the databases Medline, Embase, and PsycINFO was conducted.Results: Over 1,235 studies were identified, out of these, 107 appropriate articles were selected and discussed in the present review.Conclusion: AN has large impact on GI alterations and symptoms; conversely, GI symptoms may also affect the manifestation and course of AN as discussed in the present review. Despite increasing data, several gaps in knowledge exist especially on the pathophysiology underlying the changes described. Highlights• Gastrointestinal alterations during AN can be observed in the whole GI tract. • AN is accompanied by a high level of gastrointestinal complaints. • AN is more often the cause than the result of GI dysfunction and complaints occurring in the course of this eating disorder.

Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal‐based behavioral treatment program

“…Anorexia nervosa (AN) and underweight avoidant/restrictive food intake disorder (ARFID) are both characterized by restricted dietary intake and rapid weight loss, or severe low weight (American Psychiatric Association, 2013). GI complaints are almost ubiquitous in eating disorder populations, with up to 90% of treatment‐seeking individuals with AN reporting GI symptoms (Boyd, Abraham, & Kellow, 2005; Salvioli et al, 2013; Schalla & Stengel, 2019). For most of these individuals, symptoms and diagnoses reflect impairments in GI motility or functional GI disorders, rather than structural lesions (Kress, Paslakis, & Erim, 2018; Norris et al, 2015).…”

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa

“…Gastrointestinal (GI) symptoms are common in AN, with over 90% of patients reporting GI complaints. While the pathogenesis of GI complaints are attributed to sequelae of weight loss, there is also a significant functional component to many of the GI complaints by patients with AN [74,75].…”

“…There is experimental evidence that intestinal methane production is linked to slower intestinal transit, predisposing to constipation [81]. One study showed that, while overall microbial richness increased after weight gain, gut dysbiosis, short chain fatty acid profiles, and GI complaints remained persistent three months after weight gain [74]. Whether dysbiosis is the cause or effect of AN remains to be seen.…”

Backstage of Eating Disorder—About the Biological Mechanisms behind the Symptoms of Anorexia Nervosa

“…Motor and sensory gastroduodenal dysfunction, impaired mucosal integrity, local low-grade immune activation as well as dysregulation of the microbiome-gut-brain axis signaling are all involved in etiopathogensis of functional gastrointestinal disorders [132,202,203]. According to Schalla and Stengel (2019) long-lasting food restriction together with laxative abuse led to gastric damage including autonomic nerve dysfunction, which negatively alters local neural regulation and further leads to impaired gastric accommodation, bradygastria and decreased gastric emptying [204]. AN patients presented with an increased risk of the superior mesenteric artery syndrome development, which involves vascular compression of the distal part of the duodenum and results in vomiting and abdominal pain.…”