Esophageal motility and symptoms in restricting and binge-eating/purging anorexia.
BACKGROUND
Esophageal symptoms are common in anorexia nervosa, but it is not known whether they are associated with motility disorders, with different forms of the disease, and whether they respond to nutritional rehabilitation.


METHODS
To clarify these points, 23 patients with anorexia nervosa (12 binge-eating/purging, "purgers"; 11 restricting type, "restricters") were studied by esophageal manometry before and after 22 weeks rehabilitation. Manometric parameters of 35 age and sex-matched patients were used as controls. Patients with anorexia also filled questionnaires on eating disorder psychopathology, psychopathological distress and esophageal, gastric and colonic symptoms before and after 4 and 22 weeks of a rehabilitation program.


RESULTS
Symptoms were more severe in patients than in controls. Gastric and colonic, but not esophageal symptoms improved with treatment. LES basal pressure was higher in restricters (restricters 32.1±4.6; purgers 14.9±2.2; controls 17.1±1.1 mmHg, p<0.005), but still within normal range; this difference disappeared after treatment. Postdeglutitive body waves were normally propagated. Their amplitude was significantly higher in anorexia than in controls. No correlation was found between results of psychopathological tests (improved after treatment), esophageal symptoms and manometry.


CONCLUSIONS
In anorexia, esophageal symptoms are frequent and severe. They are not adequately explained by psychological or manometric derangements.
Benini
Luigi
L
Gastroenterology Unit, Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy. luigi.benini@univr.it
Todesco
Tiziana
T
Frulloni
Luca
L
Dalle Grave
Riccardo
R
Campagnola
Pietro
P
Agugiaro
Flora
F
Cusumano
Caterina Daniela
CD
Gabbrielli
Armando
A
Vantini
Italo
I
D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D015992:Body Mass Index; D002032:Bulimia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D031204:Caloric Restriction / Q000009:adverse effects / Q000523:psychology; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects; D015928:Cognitive Behavioral Therapy; D004035:Diet Therapy; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D006801:Humans; D018529:Nutritional Support / Q000523:psychology; D011615:Psychotherapy, Group; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013851:Thinness / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D014839:Vomiting / Q000503:physiopathology / Q000523:psychology / Q000628:therapy
D002400:Cathartics