title: Gastric emptying and symptoms of bulimia nervosa: effect of a prokinetic agent.
abstract: OBJECTIVE
  Previous studies have suggested that delayed gastric emptying and abnormal postprandial release of hormones that influence satiation, particularly cholecystokinin (CCK), may play an important role in the pathophysiology of bulimia nervosa (BN). This study was designed to test these hypotheses as well as the efficacy of the prokinetic agent erythromycin in patients with BN.
  
  
  METHODS
  Thirty-two normal-weight women with BN and 24 control participants consumed a large liquid test meal. Gastric emptying and pre- and postprandial release of CCK, peptide YY (PYY), and ghrelin were determined. Participants with BN were then recruited for double-blind treatment with erythromycin up to 500 mg three times daily vs. placebo for 6 weeks, following which they consumed a repeat test meal with gastric emptying and appetitive hormone measurements.
  
  
  RESULTS
  CCK release at 15 min following the meal was marginally lower (p=0.1) in BN than in control participants. Rate of gastric emptying and postprandial hormone release were similar in BN and controls. BN patients assigned to erythromycin compared to those assigned to placebo had more rapid gastric emptying following treatment, but there were no differences in release of CCK, PYY, or ghrelin following the post-treatment test meal. Moreover, treatment with erythromycin was not associated with clinical response.
  
  
  CONCLUSIONS
  The current study does not support the clinical utility of moderate dose erythromycin in treating BN. Furthermore, the findings suggest that a modest increase in gastric emptying rate is associated neither with altered postprandial hormonal release nor with clinical benefit in these patients. While providing no evidence for the effectiveness of prokinetic agents in this setting, our findings do not preclude the possibility that a greater increase in gastric emptying rate might prove beneficial.
authors.affiliation: Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 116, New York, NY 10032, USA. mjd5@columbia.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Devlin
authors.forename: Harry R
authors.initials: HR
authors.lastname: Kissileff
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Zimmerli
authors.forename: Francine
authors.initials: F
authors.lastname: Samuels
authors.forename: Benny E
authors.initials: BE
authors.lastname: Chen
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Brown
authors.forename: Allan
authors.initials: A
authors.lastname: Geliebter
authors.forename: B Timothy
authors.initials: BT
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D052018:Bulimia Nervosa / Q000188:drug therapy*; D002766:Cholecystokinin / Q000097:blood; D004311:Double-Blind Method; D004917:Erythromycin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D054439:Ghrelin / Q000097:blood; D006801:Humans; D008875:Middle Aged; D009037:Motilin / Q000819:agonists*; D019894:Peptide YY / Q000097:blood
chemical_list: D005765:Gastrointestinal Agents; D054439:Ghrelin; D019894:Peptide YY; D009037:Motilin; D004917:Erythromycin; D002766:Cholecystokinin