title: Vomiting and feeling fat--coincidence of achalasia and bulimia nervosa.
abstract: OBJECTIVE
  In clinical practice it is often difficult to distinguish between organic and psychological vomiting.
  
  
  METHODS
  We present a case of a 34-year-old woman with an 18-month history of vomiting with the initial diagnosis of bulimia nervosa (BN). However, the patient showed an unusual vomiting behavior. Therefore, further somatic diagnostic procedures were carried out leading to the additional diagnosis of achalasia. After successful interventional and surgical treatment for achalasia, further psychotherapeutic interventions were necessary because of worsening of the BN symptoms. A certain disturbed eating behavior seemed to persist at 3-year follow-up, while the medical condition had improved.
  
  
  CONCLUSIONS
  It needs to be emphasized that careful diagnostic steps are indispensable to distinguish between psychological vomiting and organic vomiting. In case of two separate diseases a suitable treatment regime for each is required.
authors.affiliation: Department of Internal Medicine VI-Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany. martin.teufel@med.uni-tuebingen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
authors.forename: Georg
authors.initials: G
authors.lastname: Lamprecht
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Markus
authors.initials: M
authors.lastname: Schrauth
authors.forename: Nora
authors.initials: N
authors.lastname: Rapps
authors.forename: Ute
authors.initials: U
authors.lastname: Martens
authors.forename: Gaby
authors.initials: G
authors.lastname: Gross
mesh_terms: D000328:Adult; D052018:Bulimia Nervosa / Q000150:complications* / Q000175:diagnosis*; D002404:Catheterization; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D004931:Esophageal Achalasia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D014839:Vomiting / Q000209:etiology*