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

Abstract

Objective Gastrointestinal (GI) disturbances are a frequent and burdensome experience for patients with anorexia nervosa (AN). How GI symptoms respond to current interventions is not well characterized, yet is critical to facilitate treatment success, and to inform the development of new treatments for AN. Therefore, the aim of this systematic review was to identify which treatments are effective in improving GI symptoms in patients with AN. Method A systematic search for studies of AN treatments measuring GI symptoms pre‐ and post‐treatment was conducted in May 2020 (PROSPERO ID: CRD42020181328). After removal of duplicates, title and abstracts of 3,370 studies were screened. Methodological quality was assessed using National Institute of Health Quality Assessment Tool. Results Following full‐text screening, 13 studies (12 observational studies and 1 randomized double‐blind placebo‐controlled trial) with 401 participants met eligibility criteria and were included. All observational studies included a component of nutritional rehabilitation, with half (n = 6) involving concurrent psychological treatment. The randomized controlled trial reported a drug therapy. Eleven studies reported an improvement in all (n = 6) or at least one (n = 5) patient‐reported GI symptom following treatment. Two studies reported no change. Methodological quality was fair or poor across all studies. Discussion This is the first systematic review to synthesize available evidence on the trajectory of patient‐reported GI symptoms from commencement to end of treatment for AN. The results suggest that most studies showed improvement in one or more GI symptom in response to current treatments. Future therapeutic approaches should consider GI symptoms within their design for optimal treatment adherence and outcomes.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

“…A systematic review of thirteen studies aimed to identify the most effective treatment approaches for GI disorders and AN [ 163 ]. An improvement in at least one or more GI symptoms was reported in 11 of the 13 studies, with all studies including nutritional rehabilitation, and half also included concurrent psychological treatment [ 163 ].…”

“…A systematic review of thirteen studies aimed to identify the most effective treatment approaches for GI disorders and AN [ 163 ]. An improvement in at least one or more GI symptoms was reported in 11 of the 13 studies, with all studies including nutritional rehabilitation, and half also included concurrent psychological treatment [ 163 ]. Emerging evidence on ED comorbidity with chronic GI disorders suggested that EDs are often misdiagnosed in children and adolescents due to the crossover of symptoms.…”

Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in anorexia nervosa: A review of mechanistic rationale and clinical evidence

“…GI symptoms in AN seem to mainly resolve with standard nutritional rehabilitation (West et al, 2021). However, increasing GI symptoms during the course of treatment and persistence of symptoms beyond nutritional recovery are also seen (Boyd et al, 2010;Chapelon et al, 2021;Mack et al, 2016).…”

“…While nutritional rehabilitation, a cornerstone in the AN recovery process, has been shown to improve most of the GI symptoms suffered (West et al, 2021;Riedlinger et al, 2020), the process of nutritional treatment may worsen symptoms for patients. Dysfunctions of digestive processes such as secretion of enzymes & absorption (Takimoto et al, 2014;Winter et al, 2001) may worsen gut symptoms during refeeding.…”

Diet, Digestion, and the Dietitian: A Survey of Clinicians’ Knowledge, Attitudes and Practices to Advance the Treatment of Gastrointestinal Disturbances in Individuals with Anorexia Nervosa

“…Whereas for others, the experience of GID may present as a culmination of disordered eating behaviours and psychological distress [ 6 , 7 ]. However, it is well documented that whilst GID presentation may change or improve during inpatient care [ 8 , 9 ], for many people symptoms persist after treatment for AN [ 10 ]. Therefore, greater consideration is needed regarding how GID may be targeted in the treatment of AN to improve outcomes.…”