title: Gastrointestinal complications associated with anorexia nervosa: A systematic review.
abstract: OBJECTIVE
  A systematic review identifying gastrointestinal (GI) complications attributable to anorexia nervosa (AN) was completed.
  
  
  METHODS
  Studies of any design exploring the pathogenesis of complications and treatment strategies were included. The review was completed in accordance with PRISMA standards.
  
  
  RESULTS
  A total of 123 articles were retained, including one randomized control trial. The majority of included studies were case reports and case series. Controlled studies demonstrated that patients with AN were more likely to have delays in gastric motility, gastric emptying and intestinal transit than comparator groups although results were not uniform across all studies. Published reports suggest that complications can occur at any segment of the GI tract. These issues may derive as a consequence of severe malnourishment, from eating disorder related symptoms such as self-induced purging or from the refeeding process itself. Multiple studies noted that patients with AN report high rates of GI symptoms although in the few cases where medical testing was undertaken, correlations between self-reported symptoms and measurable pathology were not demonstrated.
  
  
  CONCLUSIONS
  GI complications may occur throughout the entire GI tract in patients with AN. It is recommended that clinicians use careful judgment when pursuing targeted investigation or introducing symptom specific treatments in response to GI complaints. Evidence suggests that most GI complications resolve with refeeding and cessation of ED symptoms.
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.|Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Norris
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.|Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Harrison
authors.affiliation: Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Leanna
authors.initials: L
authors.lastname: Isserlin
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.|Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Feder
authors.affiliation: Library and Media Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sampson
mesh_terms: D000856:Anorexia Nervosa / Q000150:complications*; D005260:Female; D005746:Gastric Emptying; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008297:Male
keywords: anorexia nervosa; constipation; gastric dilatation; gastric emptying; gastric motility; gastrointestinal; review; superior mesenteric artery syndrome; systematic; transit