Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa

Malczyk, Żaneta; Oświęcimska, Joanna

doi:10.12740/pp/65274

Cited by 21 publications

(15 citation statements)

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“…Anorexia nervosa (AN) is an eating disorder characterized by weight loss due to behaviours such as the limiting of food intake, the use of a low-calorie diet, excessive exercise, usage of laxatives, and self-induced vomiting [1]. The incidence of AN is estimated at 0.3-2%, and the ratio in women and men ranges between 10:1 and 4:1 [1,2].…”

Section: Introductionmentioning

confidence: 99%

The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Morawiecka-Pietrzak

Malczyk

Dąbrowska

et al. 2021

Endokrynologia Polska

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Introduction: Inflammation is supposed to be one of the factors contributing to decreased bone mineral density (BMD) in anorexia nervosa (AN). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and cost-effective inflammatory markers, well documented as indicators of postmenopausal osteoporosis. This study aimed to assess the relationships between these ratios and BMD in girls with AN. Material and methods:The electronic records of 73 girls hospitalized for AN were analysed retrospectively. The age range of the study group was 12.56-17.67 years. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and expressed as Z-scores according to lumbar spine (s-BMD) and total body (TB-BMD) sites. NLR and PLR were calculated according to complete blood count results. Patients were divided into 2 subgroups with parallel analysesaccording to the TB-BMD criterion and the s-BMD criterion: normal (Z-score > -2.0, n = 63) and low s-BMD subgroup (Z-score ≤ -2.0, n = 10), and normal (Z-score > -2.0, n = 45) and low TB-BMD subgroup (Z-score ≤ -2.0, n = 28).Results: In the low s-BMD subgroup a tendency to an increase of mean NLR, PLR, and WBC values was observed. Respective BMD Z-score values correlated significantly and negatively with PLR in the low s-BMD (R = -0.892, p < 0.001) and normal TB-BMD (R = -0.451, p = 0.002) subgroups, while with NLR only in the normal TB-BMD subgroup (R = -0.685, p < 0.001). In the low s-BMD subgroup the PLR was shown to be a significant and independent predictor of s-BMD (β = -0.881, p < 0.001). The PLR contributed to 77.6% of the s-BMD Z-score variability (R 2 = 0.776, p < 0.001). In the normal TB-BMD subgroup, the PLR and NLR levels were significant and independent predictors of TB-BMD (β = -0.352, p = 0.004; β = -0.450, p = 0.001; β = -0.339, p = 0.005, respectively) and explained 44.4% of TB-BMD Z-score variability (R 2 = 0.444, p < 0.001). Conclusions:These results indicate that there might be a relationship between bone mass loss and inflammation expressed as NLR and PLR in adolescent girls suffering from AN. These connections seem to be dependent on the examined skeletal area. NLR and PLR, which are common indicators of morbidity and mortality in many malignancies and inflammatory chronic diseases, can also be useful in the evaluation of bone condition in adolescent females with AN. However, there is a need for further investigation in this field.

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Section: Introductionmentioning

confidence: 99%

The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Morawiecka-Pietrzak

Malczyk

Dąbrowska

et al. 2021

Endokrynologia Polska

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“…Functional Digestive Disorders according to the Rome III criteria are common in anorexia nervosa [133,134,135]. Reported lesions are dysphagia and gastric burns, described respectively in 6% and 22% of patients, with no clear link to structural involvement of the oesophagus [136].…”

Section: Resultsmentioning

confidence: 99%

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

Blanchet

Guillaume

Bat-Pitault

et al. 2019

JCM

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Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

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“…Dry mouth, inflammation, and erosion of the gums as well as angular cheilitis (inflammation of one or both corners of the mouth) tend to be frequent in AN patients due to reduced resting and stimulated salivary flow together with lowered pH of saliva [186][187][188] Heartburn, non-cardiac chest pain and dysphagia are frequently observed in patients with AN [189]. Damaged oral mucosa and esophageal acidic damage (alike gastroesophageal reflux disease) are typical for ANBP patients due to self-vomiting, and increase the risk of the dysplasia and cancer [190].…”

Section: Gastrointestinal Malfunctionmentioning

confidence: 99%

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

et al. 2020

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Anorexia nervosa (AN) represents a disorder with the highest mortality rate among all psychiatric diseases, yet our understanding of its pathophysiological components continues to be fragmentary. This article reviews the current concepts regarding AN pathomechanisms that focus on the main biological aspects involving central and peripheral neurohormonal pathways, endocrine function, as well as the microbiome–gut–brain axis. It emerged from the unique complexity of constantly accumulating new discoveries, which hamper the ability to look at the disease in a more comprehensive way. The emphasis is placed on the mechanisms underlying the main symptoms and potential new directions that require further investigation in clinical settings.

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Gastrointestinal complications and refeeding guidelines in patients with anorexia nervosa

Cited by 21 publications

References 0 publications

The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

The relationship of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with bone mineral density in adolescent girls suffering from anorexia nervosa

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

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

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