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Hepatic Complications of Anorexia Nervosa

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Abstract

Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.

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Authors and Affiliations

  1. Department of Medicine, University of Colorado, School of Medicine, 12631 E 17th Ave B178, Aurora, CO, 80045, USA

    Elissa Rosen, Hugo R. Rosen & Philip S. Mehler

  2. Department of Medicine, Denver Health Hospital, 777 Bannock Street, MC 4000, Denver, CO, 80204, USA

    Elissa Rosen, Ashlie Watters & Philip S. Mehler

  3. Division Head of the Department of Gastroenterology and Hepatology, University of Colorado, School of Medicine, 12631 E 17th Ave B158, Aurora, CO, 80045, USA

    Hugo R. Rosen

  4. ACUTE Center for Eating Disorders at Denver Health, 777 Bannock Street 5A, Denver, CO, 80204, USA

    Elissa Rosen, Ashlie Watters & Philip S. Mehler

  5. Eating Recovery Center of Denver, 1830 Franklin St #405, Denver, CO, 80218, USA

    Philip S. Mehler

  6. Eating Recovery Center of Washington, 1231 116th Ave NE #800, Bellevue, WA, 98004, USA

    Neeru Bakshi & Philip S. Mehler

Authors
  1. Elissa Rosen
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  2. Neeru Bakshi
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  3. Ashlie Watters
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  4. Hugo R. Rosen
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  5. Philip S. Mehler
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Correspondence to Elissa Rosen.

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Rosen, E., Bakshi, N., Watters, A. et al. Hepatic Complications of Anorexia Nervosa. Dig Dis Sci 62, 2977–2981 (2017). https://doi.org/10.1007/s10620-017-4766-9

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  • DOI: https://doi.org/10.1007/s10620-017-4766-9

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