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.
Similar content being viewed by others
References
Szmukler GI, Young GP, Lichtenstein M, Andrews JT: A serial study of gastric emptying in anorexia nervosa and bulimia. NZ Med J 20:220, 1990
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, 1991
Scobie BA: Acute dilation of the stomach in patients with anorexia nervosa. NZ Med J 3:335, 1972
Haller JO, Slovis TL, Baker DH: Anorexia nervosa: The paucity of radiologic findings in more than fifty patients. Pediatr Radiol 5:145, 1977
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, 1990
Scobie BA: Acute gastric dilatation and duodenal ileus in anorexia nervosa. Med J Aust 2:932, 1973
Froese AP, Szmuilowicz J, Bailey JD: The superiormesenteric-artery syndrome. Cause or complication of anorexia nervosa. Can Psychiatr Assoc J 23:325, 1978
Pentlow BD, Dent RG: Acute vascular compression of the duodenum in anorexia nervosa. Br J Surg 68:665, 1981
Kornmehl P, Weizman Z, Liss Z: Superior mesenteric artery syndrome presenting as an anorexia nervosa-like illness. J Adolesc Health Care 9:340, 1988
Cuellar RE, Van Thiel DH: Gastrointestinal consequences of the eating disorders: Anorexia nervosa and bulimia. Am J Gastroenterol 81:113, 1986
Dubois A, Gross HA, Ebert MH: Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology 77:319, 1979
Saleh JW, Lebwohl P: Metoclopramide-induced gastric emptying in patients with anorexia nervosa. Gastroenterology 74:127, 1980
Holt S, Ford MJ, Grant S: Abnormal gastric emptying in primary anorexia nervosa. Br J Psychiatr 139:550, 1981
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, 1988
Abell TL, Malagelada JR, Lucas AR: Gastric electromechanical and neurochormonal function in anorexia nervosa. Gastroenterology 93:958, 1987
Robinson PH, Clarke M, Barrett J: Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa. Gut 29:458, 1988
Abell TL, Lucas AR, Brown ML, Malageleda JR: Gastric electrical dysrhythmias in anorexia nervosa. Gastroenterology 88:1300, 1985
Feighner JP, Robins E, Guze SB: Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatr 26:57, 1982
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC, APA, 1980, p 67
Quigley EMM, Donovan JP, Lane MJ, Gallagher TF: Antroduodenal manometry. Usefulness and limitations as an outpatient study. Dig Dis Sci 37:20, 1992
Quigley EMM: Intestinal manometry—technical advances, clinical limitations. Dig Dis Sci 37:10, 1992
Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208, 1990
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 171–198
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, 1987
Mayer EA, Raybould HE: Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology 99:1688, 1990
McCallum RW, Grill BB, Lange R: Definition of a gastric emptying abnormality in patients with anorexia nervosa. Dig Dis Sci 30:713, 1985
Meyer JH: Motility of the stomach and gastroduodenal junction.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1987, pp 613–630
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Buchman, A.L., Ament, M.E., Weiner, M. et al. Reversal of megaduodenum and duodenal dysmotility associated with improvement in nutritional status in primary anorexia nervosa. Digest Dis Sci 39, 433–440 (1994). https://doi.org/10.1007/BF02090220
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02090220