Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa.

Abstract

SUMMARY Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p<0.01) by domperidone. Conclusions: (1) symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; (2) clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; (3) delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

“…Interestingly, studies using an OGTT have also found a delay in the insulin response curve in both ill (39) and weight-restored AN subjects (10). Gastric and gut dysmotility associated with AN (26,34) may be an additional factor contributing to the right shift in glucose and insulin response curves observed in AN compared with control subjects, and the lower AUC for glucose and insulin in starved AN may reflect malabsorption. We cannot, however, explain why the AUC for insulin at AN1 is comparable to that of controls whereas it is depressed at AN2 and AN3 as though there is increased sensitivity to insulin with refeeding.…”

Gastric adenocarcinoma mistakenly diagnosed as an eating disorder: Case report

“…In particular, achalasia, which often presents with dysphagia, regurgitation of food, weight loss, and avoidance of eating, has been described in case reports [2][3][4][5][6] and series 7 to have been misdiagnosed as anorexia nervosa. Desseilles et al 2 describe the case of a 24-year-old man presenting with weight loss and postprandial vomiting, and diagnosed with an atypical eating disorder, who was subsequently discovered to have a grossly dilated esophagus due to achalasia.…”

“…Marshall and Russell 5 describe a 30-year-old woman who was treated on a psychiatric unit for atypical anorexia nervosa for 2 months, before the correct diagnosis of achalasia was made. Finally, Stacher et al 7 reported on a series of 30 patients meeting the criteria for anorexia nervosa, seven of whom were found to have primary achalasia causing their symptoms. In a related article, 6 they note that while inadequate history-taking and clinical bias can contribute to misdiagnosis, patients themselves may come to misinterpret their physical symptoms as being psychological in origin.…”

Achalasia mimicking prepubertal anorexia nervosa

“…Although reports of achalasia in adults and adolescents misdiagnosed as eating disorders exist in the literature (Kenney, 1984;Stacher, Kiss, Wiesnagrotzki, Bergmann, Hö bart, & Schneider, 1986;Stacher, Wiesnagrotzki, & Kiss, 1990;Wright, Smith, & Mitchell, 1990), the differential diagnosis of anorexia nervosa can cause diagnostic confusion. In the case just presented, the patient had lost weight and had a number of additional problems; yet two core criteria for a diagnosis of anorexia nervosa have not been met: the patient presented no body image distortion, and the absence of somatic pathology was not confirmed.…”