Anorexia nervosa in gastrointestinal practice.
ABSTRACT To characterize the demographic, psychosocial and prognostic features of patients with anorexia nervosa (AN) presenting to a gastroenterology service, and to compare them with patients presenting to an eating disorders unit.
A retrospective study set in two centres providing a local and tertiary service for gastroenterology and eating disorders. The notes of 20 consecutive patients with AN from each centre were compared. Comparison was made with a control group of 20 consecutive patients with slow transit constipation presenting to a gastroenterology service.
Patients with AN who presented to a gastroenterology service were significantly older, had often seen a large number of hospital specialists, had a spectrum of gastrointestinal complaints, suffered a substantial delay in being diagnosed, and had undergone a significantly greater number of investigations and hospital admissions than AN patients attending an eating disorders unit. The parents of AN patients presenting to a gastroenterology clinic had a greater burden of physical and psychiatric illness than the parents in either of the other groups, and also tended to have separated when the patients were under the age of 10 years. Adverse prognostic factors among AN patients presenting to a gastroenterology clinic included older age at presentation, long history, unemployment, early parental separation and a body mass index less than 17.
Patients with AN presenting to a gastroenterology service have profound psychosocial morbidity in excess of those presenting to a specialist eating disorders unit. Their diagnosis is often delayed. Early recognition and prompt referral to a specialist eating disorder unit should form the basis of management.
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ABSTRACT: Hintergrund: Das Ziel der Studie war es, die Prävalenz somatoformer Beschwerden und ihre Bewertung bei vier Gruppen von ambulanten Psychosomatik-Patientinnen zu untersuchen. Methode: In einer konsekutiven Querschnittstudie wurden 201 ambulante Psychosomatik-Patientinnen (Altersmittelwert 39.1 Jahre, SD 11.8) mit den Diagnosen Depression, Angststörungen, somatoforme Störungen und Essstörungen mit dem Screening für Somatoforme Symptome (SOMS-2) un-tersucht. Ergebnisse: Über alle Items des SOMS-2 hinweg zeigten die vier diagno-stischen Gruppen eine ähnliche Anzahl somatoformer Beschwerden (p = 0.855). Im Durchschnitt wurden über alle Gruppen hinweg rund 15 somato-forme Beschwerden berichtet. Bei einigen SOMS-Items fanden sich jedoch klare Häufigkeitsunterschiede zwischen den vier Gruppen. Obwohl die Pa-tientinnen mit somatoformen Störungen nicht häufiger Schmerzen ohne or-ganische Ursachen aufwiesen als die anderen Patientinnen, beschäftigten sie jedoch diese Schmerzen häufiger stark (p ≤ 0.001). Diskussion: Patientinnen mit somatoformen Störungen berichteten nicht mehr über körperliche Beschwerden ohne organische Ursachen als Patien-tinnen mit Depressionen, Angst-oder Essstörungen. Abstract Introduction: The aim of the current study was to examine the prevalence of somatoform symptoms and their attribution in four different psychosomatic female outpatient groups. Methods: In a consecutive cross-sectional study 201 outpatients (age 39.1 years, SD 11.8) suffering from depression, anxiety disorders, somato-form disorders, and eating disorders were assesssed with the Screening for Somatoform Symptoms (SOMS-2). Results: The four diagnostic groups did not differ significantly in the preva-lence of somatoform complaints (p = 0.855). On average, each group re-ported about 15 somatoform complaints. But there were some group differ-ences with regard to specific SOMS-items. Although patients with somatoform disorders did not report more physical complaints than the other three diagnostic groups they were more concerned with cognitions with regard to pain symptoms (p ≤ 0.001). Discussion: Female patients with somatoform disorders did not report more somatoform symptoms than female patients with depression, anxiety or eat-ing disorders.
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ABSTRACT: Background and AimBehavioral therapy is effective in patients with chronic intractable constipation despite standard treatment, but long-term results in unselected patients are unclear. This study investigates the effects of behavioral therapy on symptoms, subjective well-being and physical and mental quality of life.Methods Patients who had failed standard care for idiopathic chronic constipation underwent behavioral therapy in a specialist clinic. Symptom severity and quality of life were assessed before and after therapy using the “constipation scoring system” and SF-36 questionnaire. The primary outcome was subjective perception of improvement. Secondary outcomes were symptoms of constipation and quality of life scores.ResultsOf 233 consecutive patients with self-reported constipation (median symptom duration 5-10 years, median age 44 years, females 86%), 180 (77%) completed treatment in a median of 3 (range 1 - 7) sessions. One-hundred and sixty-five patients (71% of all referrals or 92% of those completing treatment) reported subjective improvement. Median bowel frequency improved from once every 2-7 days to 1-3 per day (p=0.05). Pain and bloating improved in more than 80% of patients. SF-36 physical (p < 0.05) and mental (p < 0.05) composite scores improved significantly. Patients with a longer duration of symptoms were less likely to complete treatment. Digital evacuation prior to treatment was a predictor of poor outcome.Conclusion Behavioural therapy is associated with significant improvement in symptoms of chronic constipation and quality of life. Non-drug therapies that successfully treat patients with functional gut disorders resistant to standard treatment are needed in the mainstream provision of care.Internal Medicine Journal 06/2014; 44(9). DOI:10.1111/imj.12490 · 1.70 Impact Factor
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ABSTRACT: Anorexia nervosa is a severe eating disorder often leading to malnutrition and cachexia, but its pathophysiology is still poorly defined. Chronic food restriction during anorexia nervosa may induce gut barrier dysfunction, which may contribute to disease development and its complications. Here we have characterized intestinal barrier function in mice with activity-based anorexia (ABA), an animal model of anorexia nervosa. Male C57Bl/6 ABA or limited food access (LFA) mice were placed respectively in cages with or without activity wheel. After 5 days of acclimatization, both ABA and LFA mice had progressively limited access to food from 6 h/d at day 6 to 3 h/d at day 9 and until the end of experiment at day 17. A group of pair-fed mice (PF) was also compared to ABA. On day 17, food intake was lower in ABA than LFA mice (2.0 ± 0.18 g vs. 3.0 ± 0.14 g, p < 0.001) and weight loss was more pronounced in ABA and PF compared to LFA mice (23.6 ± 1.6% and 24.7 ± 0.7% vs. 16.5 ± 1.2%; p < 0.05). Colonic histology showed decreased thickness of the muscularis layer in ABA compared to LFA mice (p < 0.05). Colonic permeability was increased in both ABA and PF compared to LFA mice (p < 0.05) but jejunal paracellular permeability was not affected. Expression of claudin-1 in the colon was lower in the ABA than the LFA group (p < 0.05), whereas occludin expression remained unaffected. Increased colonic permeability and histological alterations found in ABA mice suggest that intestinal barrier dysfunction may also occur in anorexia nervosa. The role of these alterations in the pathophysiology of anorexia nervosa should be further evaluated.Clinical nutrition (Edinburgh, Scotland) 11/2013; DOI:10.1016/j.clnu.2013.11.006 · 3.27 Impact Factor