title: A series of patients with purging type anorexia nervosa who do "tube vomiting".
abstract: BACKGROUND
  It is important for clinicians to assess their patients' purging behavior. Various methods of purging, such as self-induced vomiting are well-known. Because patients do not always report their purging behavior, knowing the clinical signs that indicate the behavior is useful. However, we have experienced patients who did not have the reported physical signs of self-induced vomiting because they used hoses instead of their fingers to purge their stomach contents, which they call "tube vomiting". No other previous studies have reported the use of hoses as a purging tool.
  
  
  METHODS
  We present as our main case a 20-year-old Japanese woman with anorexia nervosa who engaged in "tube vomiting." Although she recovered well under medical treatment in our hospital, she began to lose weight and blood potassium soon after discharge. We found that she used a garden hose instead of her fingers to perform self-induced vomiting,. She inserted the hose into her stomach and evacuated the stomach contents through it, without pain. She learned this technique through a blog about eating disorders. We also present two other similar cases. In fact, many patients discuss "tube vomiting" on the internet.
  
  
  CONCLUSIONS
  Our experience suggests that a sudden decrease in the weight and blood potassium level could indicate "tube vomiting". In addition, because many information resources are available on the internet, medical practitioners should be aware of these sites.
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Horie
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Saki
authors.initials: S
authors.lastname: Harashima
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yoneda
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Hiraide
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Inada
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Otani
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiro
authors.identifier: 0000-0002-8164-4910
authors.initials: K
authors.lastname: Yoshiuchi
keywords: Anorexia nervosa; Purging; Tube vomiting