Advertisement

Digestive Diseases and Sciences

, Volume 39, Issue 2, pp 433–440 | Cite as

Reversal of megaduodenum and duodenal dysmotility associated with improvement in nutritional status in primary anorexia nervosa

  • Alan L. Buchman
  • Marvin E. Ament
  • Marvin Weiner
  • Anatoly Kodner
  • Emeran A. Mayer
Case Report

Summary

Anorexia nervosa is considered one type of eating disorder that may result in severe malnutrition. Patients with this disorder commonly complain of postprandial nausea, abdominal pain, and distension. We describe the radiologic and motility abnormalities associated with anorexia nervosa in a 21-year-old female. Barium gastrointestinal series demonstrated marked dilation of the duodenum, with prolongation of intestinal transit. A 4-hr fasting gastroduodenal motility study showed no propagating migrating motor complexes (MMC). Prolonged, but nonpropagating, bursts of high-amplitude phasic and tonic contractions were seen in the duodenum. In contrast, antral contractions were of low amplitude and esophageal motor function was normal. Metoclopramide and edrophonium caused an increase in gastroduodenal motor activity, but increased contractions were not associated with symptoms. Following a renutrition program that raised the patient's weight from 64 to 80% of her ideal body weight, the radiographic abnormalities and gastrointestinal dysmotility resolved completely. These observations suggest that anorexia-associated gastrointestinal motor dysfunctions are a consequence, not the cause of the generalized protein-calorie malnutrition associated with anorexia nervosa. The facts that motility in different parts of the gut is affected to different degrees and that gastric and duodenal muscle responds normally to exogenous stimulation argue against a generalized myogenic dysfunction and, rather, point to a reversible dysfunction of neural regulation.

Key words

anorexia nervosa antroduodenal motility dysmotility pseudobstruction malnutrition 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Szmukler GI, Young GP, Lichtenstein M, Andrews JT: A serial study of gastric emptying in anorexia nervosa and bulimia. NZ Med J 20:220, 1990Google Scholar
  2. 2.
    Kamal N, Chami T, Andersen A, Rosell FA, Schuster MM, Whitehead WE: Delayed gastrointestinal transit times in anorexia nervosa and bulimia nervosa. Gastroenterology 101:1320, 1991Google Scholar
  3. 3.
    Scobie BA: Acute dilation of the stomach in patients with anorexia nervosa. NZ Med J 3:335, 1972Google Scholar
  4. 4.
    Haller JO, Slovis TL, Baker DH: Anorexia nervosa: The paucity of radiologic findings in more than fifty patients. Pediatr Radiol 5:145, 1977Google Scholar
  5. 5.
    Hirakawa M, Okada T, Iida M, Tamai H, Kobayashi N, Nakagawa T, Fujishima M: Small bowel transit time measured by hydrogen breath test in patients with anorexia nervosa. Dig Dis Sci 35:733, 1990Google Scholar
  6. 6.
    Scobie BA: Acute gastric dilatation and duodenal ileus in anorexia nervosa. Med J Aust 2:932, 1973Google Scholar
  7. 7.
    Froese AP, Szmuilowicz J, Bailey JD: The superiormesenteric-artery syndrome. Cause or complication of anorexia nervosa. Can Psychiatr Assoc J 23:325, 1978Google Scholar
  8. 8.
    Pentlow BD, Dent RG: Acute vascular compression of the duodenum in anorexia nervosa. Br J Surg 68:665, 1981Google Scholar
  9. 9.
    Kornmehl P, Weizman Z, Liss Z: Superior mesenteric artery syndrome presenting as an anorexia nervosa-like illness. J Adolesc Health Care 9:340, 1988Google Scholar
  10. 10.
    Cuellar RE, Van Thiel DH: Gastrointestinal consequences of the eating disorders: Anorexia nervosa and bulimia. Am J Gastroenterol 81:113, 1986Google Scholar
  11. 11.
    Dubois A, Gross HA, Ebert MH: Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology 77:319, 1979Google Scholar
  12. 12.
    Saleh JW, Lebwohl P: Metoclopramide-induced gastric emptying in patients with anorexia nervosa. Gastroenterology 74:127, 1980Google Scholar
  13. 13.
    Holt S, Ford MJ, Grant S: Abnormal gastric emptying in primary anorexia nervosa. Br J Psychiatr 139:550, 1981Google Scholar
  14. 14.
    Rigaud D, Bedig G, Merrouche M: Delayed gastric emptying in anorexia nervosa is improved by completion of a renutrition program. Dig Dis Sci 33:919, 1988Google Scholar
  15. 15.
    Abell TL, Malagelada JR, Lucas AR: Gastric electromechanical and neurochormonal function in anorexia nervosa. Gastroenterology 93:958, 1987Google Scholar
  16. 16.
    Robinson PH, Clarke M, Barrett J: Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa. Gut 29:458, 1988Google Scholar
  17. 17.
    Abell TL, Lucas AR, Brown ML, Malageleda JR: Gastric electrical dysrhythmias in anorexia nervosa. Gastroenterology 88:1300, 1985Google Scholar
  18. 18.
    Feighner JP, Robins E, Guze SB: Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatr 26:57, 1982Google Scholar
  19. 19.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC, APA, 1980, p 67Google Scholar
  20. 20.
    Quigley EMM, Donovan JP, Lane MJ, Gallagher TF: Antroduodenal manometry. Usefulness and limitations as an outpatient study. Dig Dis Sci 37:20, 1992Google Scholar
  21. 21.
    Quigley EMM: Intestinal manometry—technical advances, clinical limitations. Dig Dis Sci 37:10, 1992Google Scholar
  22. 22.
    Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208, 1990Google Scholar
  23. 23.
    Kellow JE, Phillips SF: Functional disorders of the small intestine.In Pathogenesis of Functional Bowel Disease. W Snape Jr (ed). New York, Plenum Press, 1989, pp 171–198Google Scholar
  24. 24.
    Stacher G, Bergmann H, Wiesnagrotzki S, Kiss A, Schneider C, Mittelbach G, Gaupmann G, Hoebart J: Intravenous cisapride accelerates delayed gastric emptying and increases antral contraction amplitude in patients with primary anorexia nervosa. Gastroenterology 92:1000, 1987Google Scholar
  25. 25.
    Mayer EA, Raybould HE: Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology 99:1688, 1990Google Scholar
  26. 26.
    McCallum RW, Grill BB, Lange R: Definition of a gastric emptying abnormality in patients with anorexia nervosa. Dig Dis Sci 30:713, 1985Google Scholar
  27. 27.
    Meyer JH: Motility of the stomach and gastroduodenal junction.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1987, pp 613–630Google Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Alan L. Buchman
    • 1
    • 2
  • Marvin E. Ament
    • 1
    • 2
  • Marvin Weiner
    • 1
    • 2
  • Anatoly Kodner
    • 1
    • 2
  • Emeran A. Mayer
    • 1
    • 2
  1. 1.From the Division of Pediatric Gastroenterology and Nutrition and Department of RadiologyUCLA Medical CenterLos Angeles
  2. 2.Center for Ulcer Research and Education (CURE), Department of MedicineUCLA and Wadsworth VA Medical CenterLos Angeles

Personalised recommendations