Hyperamylasemia and bulimia: A clinical review

Abstract

Hyperamylasemia, often with abdominal symptoms, commonly occurs in patients with bulimia as well as in pancreatitis. Eleven bulimic patients presenting with hyperamylasemia are described; one case is described in detail. Of the 11, the source of amylase in 10 was salivary, not pancreatic. A careful history with questions about weight changes, eating behavior, body image, methods of weight control and purging, as well as a complete mental status examination should be done on females presenting with the above symptoms. Doing this will prevent unncessary procedures, drug prescription, hospitalizations, and latrogenic illness.

Significance of vomiting for hyperamylasemia and sialadenosis in patients with eating disorders

“…The S3 fraction was not found in 3 of 13 patients with bulimia or in 2 of the 16 patients with bulimia. These findings are in agreement with another report (Kaplan, 1987) that found 10 of 11 bulimics to have elevated salivary isoenzymes. Only 2 of the 16 restrictor anorectics demonstrated modestly elevated serum lipase activity; both patients also showed pathologically but modestly elevated P-amylase activity in serum.…”

“…No significant difference in serum lipase activity (p = .32) was found between the two groups. Other researchers (Kaplan, 1987;Humphries et al, 1987) also demonstrated that pancreas involvement in hyperamylasemia in patients with eating disorders can be largely ruled out. Of the patients with bulimia nervosa, 20% can be termed ruminants (Levine, Wingate, & Pfeffer, 1983;Fairburn & Cooper, 1984;Blinder, 1986;Larocca & Della-Fera, 1987).…”

“…The present study supports the findings of other investigators that patients with eating disorders have salivary gland enlargements and an increase of total serum amylase. Furthermore, hyperamylasemia is accounted for by an increase in serum amylase of the salivary type, but not of the pancreatic type (Gwirtsman et al, 1986(Gwirtsman et al, , 1989Humphries et al, 1987;Kaplan, 1987;Levin et al, 1980;Walsh et al, 1981;Walsh, Wong, Pesce, Hadigan, & Bodourian, 1990). Only two (twelve %) of the restrictor anorectics also showed pathologically elevated lipgse activity in serum besides increased P-amylase activity.…”

Painful buccal mass in a patient with bulimia nervosa

“…The medical complications of bulimia nervosa have been well described. These complications are multisystemic and include abnormalities in the head and neck (Kaplan, 1987;Pyle, Mitchell and Eckert, 1981). For the most part, these have been primarily dental (caries, gingivities, and demineraliza tion with loss of tooth substance), but bilateral parotid gland enlargement has also been identified.…”

“…For the most part, these have been primarily dental (caries, gingivities, and demineraliza tion with loss of tooth substance), but bilateral parotid gland enlargement has also been identified. Parotid involvement, although relatively uncommon, is usually painless and often accompanied by salivary hyperamylasemia (Kaplan, 1987).…”