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Medical complications of bulimia nervosa and their treatments

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity volume 21, pages 13–18 (2016)Cite this article

Abstract

Purpose

The purpose of this article is to thoroughly review the medical complications associated with bulimia nervosa and their evidenced-based or typical treatments.

Methods

A thorough review of medical literature to cull pertinent and best articles which guide the diagnosis and treatment of the medical complications of bulimia nervosa was performed.

Results

There are many different medical complications of bulimia nervosa which are caused by the mode and frequency of purging. Some are fluid and electrolyte alterations from the utilized mode of purging and some are due to the local damaging effects of purging behaviors on those body sites.

Conclusion

Bulimia nervosa is a serious mental health disorder which has many medical complications associated with it. Most are reversible with treatment.

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References

  1. American Psychiatric Association (2013) DSM-5-diagnostical and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, USA. ISBN-10: 0890425558

  2. Steffen KJ, Mitchell JE, Roerig JL, Lancaster KL (2007) The eating disorders medicine cabinet revisited: a clinicians guide to ipecac and laxatives. Int J Eat Disord 40:360–368. doi:10.1002/eat.20365

    Article  PubMed  Google Scholar 

  3. Kadrmas EF, Pach JM (1995) Vitreous hemorrhage and retinal vein rupture. Am J Ophthalmol 120:114–115. doi:10.1016/S0002-9394(14)73769-9

    CAS  Article  PubMed  Google Scholar 

  4. Uhlen MM, Tveit AB, Stenhagen KR, Mulic A (2014) Self-induced vomiting and dental erosion–a clinical study. BMC Oral Health 14:92. doi:10.1186/1472-6831-14-92

    Article  PubMed  PubMed Central  Google Scholar 

  5. Johansson AK, Norring C, Unell L, Johansson A (2012) Eating disorders and oral health: a matched case–control study. Eur J Oral Sci 120:61–68. doi:10.1111/j.1600-0722.2011.00922

    Article  PubMed  Google Scholar 

  6. Altshuler BD, Dechow PC, Waller DA, Hardy BW (1990) An investigation of the oral pathologies occurring in bulimia nervosa. Int J Eat Disord 9:191–199. doi:10.1002/1098-108X(199003)9:2<191:AID-EAT2260090208>3.0.CO;2-N

    Article  Google Scholar 

  7. Christensen GJ (2002) Oral care for patients with bulimia. J Am Dent Assoc 133:1689–1691

    Article  PubMed  Google Scholar 

  8. Brown CA, Mehler PS (2013) Medical complications of self-induced vomiting. Eat Disord 21:287–294. doi:10.1080/10640266.2013.797317

    Article  PubMed  Google Scholar 

  9. Ferreira CP, Gama AC, Santos MA, Maia MO (2010) Laryngeal and vocal analysis in bulimic patients. Braz J Otorhinolaryngol 76:469–477. doi:10.1590/S1808-86942010000400011

    Article  PubMed  Google Scholar 

  10. Rajiah K, Mathew EM, Veettil SK, Kumar S (2012) Bulimia nervosa and its relation to voice changes in young adults: A simple review of epidemiology, complications, diagnostic criteria and management. J Res Med Sci 17:689–693

    PubMed  PubMed Central  Google Scholar 

  11. Coleman H, Altini M, Nayler S, Richards A (1998) Sialadenosis: a presenting sign in bulimia. Head Neck 20:758–762. doi:10.1002/(SICI)1097-0347(199812)20:8<758:AID-HED16>3.0.CO;2-N

    CAS  Article  PubMed  Google Scholar 

  12. Mignogna MD, Fedele S, Lo Russo L (2004) Anorexia/bulimia-related sialadenosis of palatal minor salivary glands. J Oral Pathol Med 33:441–442. doi:10.1111/j.1600-0714.2004.00208.x

    CAS  Article  PubMed  Google Scholar 

  13. Kinzl J, Biebl W, Herold M (1993) Significance of vomiting for hyperamylasemia and sialadenosis in patients with eating disorders. Int J Eat Disord 13:117–124. doi:10.1002/1098-108X(199301)13:1<117:AID-EAT2260130114>3.0.CO;2-8

    CAS  Article  PubMed  Google Scholar 

  14. Mehler PS, Wallace JA (1993) Sialadenosis in bulimia: anew treatment. Arch Otolaryngol Head Neck Surg 119:787–788. doi:10.1001/archotol.1993.01880190083017

    CAS  Article  PubMed  Google Scholar 

  15. Wilson T, Price T (2003) Revisiting a controversial surgical technique in the treatment of bulimic parotid hypertrophy. Am J Otolaryngol 24:85–88. doi:10.1053/ajot.2003.22

    Article  PubMed  Google Scholar 

  16. Denholm M, Jankowski J (2011) Gastroesophageal reflux disease and bulimia nervosa—a review of the literature. Dis Esophagus 24:79–85. doi:10.1111/j.1442-2050.2010.01096

    CAS  Article  PubMed  Google Scholar 

  17. Kiss A, Wiesnagrotzki S, Abatzi T, Meryn S, Haubenstock A, Base W (1989) Upper gastrointestinal endoscopy findings in patients with long-standing bulimia nervosa. Gastrointest Endosc 35:516–518. doi:10.1016/S0016-5107(89)72901-1

    CAS  Article  PubMed  Google Scholar 

  18. Walker ES (1985) Bulimia and gastric cancer. Ann Intern Med 103:305. doi:10.7326/0003-4819-103-2-305_1

    CAS  Article  PubMed  Google Scholar 

  19. Mullai N, Sivarajan K, Shiomoto G (1991) Barrett esophagus. Ann Intern Med 114:913. doi:10.7326/0003-4819-114-10-913_1

    CAS  Article  PubMed  Google Scholar 

  20. Navab F, Avunduk C, Gang D, Frankel K (1996) Bulimia nervosa complicated by Barrett’s esophagus and esophageal cancer. Gastrointest Endosc 44:492–494

    CAS  Article  PubMed  Google Scholar 

  21. Dessureault S, Coppola D, Weitzner M, Powers P, Karl RC (2002) Barrett’s esophagus and squamous cell carcinoma in a patient with psychogenic vomiting. Int J Gastrointest Cancer 32:57–61. doi:10.1385/IJGC:32:1:57

    Article  PubMed  Google Scholar 

  22. Spechler SJ, Souza RF (2014) Barrett’s esophagus. N Engl J Med 371:836–845. doi:10.1056/NEJMra1314704

    CAS  Article  PubMed  Google Scholar 

  23. Mitchell JE, Seim HC, Colon E, Pomeroy C (1987) Medical complications and medical management of bulimia. Ann Intern Med 107:71–77. doi:10.7326/0003-4819-107-1-71

    CAS  Article  PubMed  Google Scholar 

  24. Wood GJ, Shega JW, Lynch B, Von Roenin JH (2007) Management of intractable nausea and vomiting in patients at the end of life: “I was feeling nauseous all of the time…nothing was working”. JAMA 298:1196–1207. doi:10.1001/jama.299.15.1826

    CAS  Article  PubMed  Google Scholar 

  25. Brown CA, Mehler PS (2012) Successful “detoxing” from commonly utilized modes of purging in bulimia nervosa. Eat Disord 20:312–320. doi:10.1080/10640266.2012.689213

    Article  PubMed  Google Scholar 

  26. Bahia A, Mascolo M, Gaudiani JL, Mehler PS (2012) PseudoBartter syndrome in eating disorders. Int J Eat Disord 45:150–153. doi:10.1002/eat.20906

    Article  PubMed  Google Scholar 

  27. Trent SA, Moreira ME, Colwell CB, Mehler PS (2013) ED management of patients with eating disorders. Am J Emerg Med 31:859–865. doi:10.1016/j.ajem.2013.02.035

    Article  PubMed  Google Scholar 

  28. Mehler PS (2011) Medical complications of bulimia nervosa and their treatments. Int J Eat Disord 44:95–104. doi:10.1002/eat.20825

    PubMed  Google Scholar 

  29. Buchanan R, Ngwira J, Amsha K (2011) Prolonged QT interval in bulimia nervosa. BMJ Case Rep. doi:10.1136/bcr.01.2011.3780

    PubMed  PubMed Central  Google Scholar 

  30. Finsterer J, Stöllberger C (2014) Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case. Rev Med Chil 142:799–802. doi:10.4067/S0034-98872014000600016

    Article  PubMed  Google Scholar 

  31. Piotrowicz E, Orzechowski P, Bilinska M, Przybylski A, Szumowski L, Piotrowicz R (2014) Implantable cardioverter-defibrillator therapy in a 34-year-old patient with eating disorders and after the third sudden cardiac arrest. Int J Eat Disord 48:253–257. doi:10.1002/eat.22259

    Article  PubMed  Google Scholar 

  32. Silber TJ (2005) Ipecac syrup abuse, morbidity, and mortality: isn’t it time to repeal its over-the-counter status? J Adolesc Health 37:256–260. doi:10.1016/j.jadohealth.2004.08.022

    Article  PubMed  Google Scholar 

  33. Ho PC, Dweik R, Cohen MC (1998) Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion. Clin Cardiol 21:780–783. doi:10.1002/clc.4960211018

    CAS  Article  PubMed  Google Scholar 

  34. Mascolo M, Trent S, Colwell C, Mehler PS (2012) What the emergency department needs to know when caring for your patients with eating disorders. Int J Eat Disord 45:977–981. doi:10.1002/eat.22035

    Article  PubMed  Google Scholar 

  35. Sterns RH (2015) Disorders of plasma sodium—causes, consequences and correction. N Engl J Med 372:55–65. doi:10.1056/NEJMra1404489

    Article  PubMed  Google Scholar 

  36. Jensen HK, Brabrand M, Vinholt PJ, Hallas J, Lassen AT (2015) Hypokalemia in acute medical patients: risk factors and prognosis. Am J Med 128:60–67. doi:10.1016/j.amjmed.2014.07.022

    CAS  Article  PubMed  Google Scholar 

  37. Heilburn N (1943) Roentgen evidence suggesting enterocolitis associated with prolonged cathartic abuse. Radiology 41:486–491. doi:10.1148/41.5.486

    Article  Google Scholar 

  38. Smith B (1968) Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut 9:139–143. doi:10.1136/gut.9.2.139

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. Riemann JF, Schmidt H (1982) Ultrastructural changes in the gut autonomic nervous system following laxative abuse and in other conditions. Scand J Gastroenterol Suppl 71:111–1124

    CAS  PubMed  Google Scholar 

  40. Muller-Lissner S (1996) What has happened to the cathartic colon? Gut 39:486–488. doi:10.1136/gut.39.3.486

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. Joo JS, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner SD, Zaitman D, Secrest K (1998) Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. J Clin Gastroenterol 26:283–286

    CAS  Article  PubMed  Google Scholar 

  42. Bryant-Waugh R, Turner H, East P, Gamble C, Mehta R (2006) Misuse of laxatives among adult outpatients with eating disorders: prevalence and profiles. Int J Eat Disord 39:404–409. doi:10.1002/eat.20267

    Article  PubMed  Google Scholar 

  43. Malik M, Stratton J, Sweeney WB (1997) Rectal prolapse associated with bulimia nervosa: report of seven cases. Dis Colon Rectum 40:1382–1385

    CAS  Article  PubMed  Google Scholar 

  44. Ahmed S, Gunaratnam NT (2003) Images in clinical medicine. Melanosis coli. N Eng J Med 349:1349

    CAS  Article  Google Scholar 

  45. Shelton JH, Santa Ana CA, Thompson DR, Emmett M, Fordtran JS (2007) Factitious diarrhea induced by stimulant laxatives: accuracy of diagnosis by a clinical reference laboratory using thin layer chromatography. Clin Chem 53:85–90. doi:10.1373/clinchem.2006.077883

    CAS  Article  PubMed  Google Scholar 

  46. Dukas L, Willett WC, Colditz GA, Fuchs CS, Rosner B, Giovannucci EL (2000) Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women. Am J Epidemiol 151:958–964

    CAS  Article  PubMed  Google Scholar 

  47. Colton P, Woodside DB, Kaplan AS (1997) Laxative withdrawal in eating disorders. Treatment protocol and 3 to 20 year follow up. Int J Eat Disord 25:311–317. doi:10.1002/(SICI)1098-108X(199904)25:3<311:AID-EAT9>3.0.CO;2-L

    Article  Google Scholar 

  48. Shah BJ, Rughwani N, Rose S (2015) Constipation. Ann Intern Med 162:ITC1–ITC15. doi:10.7326/AITC201504070

    Article  PubMed  Google Scholar 

  49. Chu ES, Gaudiani JL, Mascolo M, Statland B, Sabel A, Carroll K, Mehler PS (2012) ACUTE center for eating disorders. J Hosp Med 7:340–344. doi:10.1002/jhm.1906

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. ACUTE at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA

    Katherine Sachs & Philip S. Mehler

  2. Eating Recovery Center, 7351 E Lowry Blvd, Suite 200, Denver, CO, 80230, USA

    Philip S. Mehler

Authors
  1. Katherine Sachs
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  2. Philip S. Mehler
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Corresponding author

Correspondence to Philip S. Mehler.

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Conflict of interest

Dr. Philip S. Mehler and Dr. Katherine Sachs declare that they have no significant competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cite this article

Sachs, K., Mehler, P.S. Medical complications of bulimia nervosa and their treatments. Eat Weight Disord 21, 13–18 (2016). https://doi.org/10.1007/s40519-015-0201-4

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  • DOI: https://doi.org/10.1007/s40519-015-0201-4

Keywords

  • Bulimia nervosa
  • Medical complications
  • Gastrointestinal
  • Electrolyte