The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.

/pdf/gastrointestinal-symptoms-and-disorders-in-patients-with-2u80mrk1gr.pdf

Gastrointestinal symptoms and disorders in patients with eating disorders

Eating disorders are commonly considered diagnoses in young women who present with unexplained weight loss and vomiting. Our objective was to report the increased awareness of eating disorders and that it is likewise important to recognize that organic pathology (achalasia) can cause symptoms that may mimic an eating disorder and lead to misdiagnosis. Two case reports are presented and a review of the existing literature is provided. In the first patient, initial diagnosis of nonclassified eating disorder based on a pubertal conflict was made, and 3.5 years later diagnosis of primary achalasia was established. Atypical bulimia nervosa was initially suspected in the other case, but diagnosis of achalasia was established at an early stage of evaluation. The exclusion of organic disease must be a priority, even if a psychotherapeutic intervention may be needed in the global care of eating disorder patients. Esophageal achalasia should be considered in anyone presenting with difficulty swallowing or dysphagia, even if other features suggest anorexia nervosa or bulimia nervosa.

Achalasia mistaken as eating disorders: report of two children and review of the literature.

Several treatment options are available in the management of achalasia of the cardia. Of a recent series of 14 children, 12 were treated by a modified Heller's myotomy combined with a floppy Nissen fundoplication. Symptoms were dramatically improved in nine during a mean follow up period of 3.9 years. Recurrent oesophageal pain was the most resistant symptom and continued to be moderately severe in three patients, two of whom obtained temporary relief by oesophageal balloon dilatation. Two patients treated by pneumatic dilatation alone have residual symptoms. These results support a primary surgical approach to the management of achalasia in children.

https://adc.bmj.com/content/archdischild/68/6/749.full.pdf

Current results of surgery for achalasia of the cardia.

(2003). Gut Function in Anorexia Nervosa and Bulimia Nervosa. Scandinavian Journal of Gastroenterology: Vol. 38, No. 6, pp. 573-587.

Gut function in anorexia nervosa and bulimia nervosa.

Introduction
Achalasia is a rare oesophageal motility disorder characterized by physical, behavioural and psychosocial features that are strikingly similar to eating disorders (ED).

Method
A literature search of PubMed and Google Scholar identified 36 cases of achalasia from 11 countries misdiagnosed as ED between 1980 and 2013.

Results
On average, the typical misdiagnosed case was an 18-year-old female with an average weight loss of 16.2 kg. Vomiting behaviour in achalasia was distinguished by occurring after both solids and liquids, occurring in public, and worsening at night or while lying down, and was associated with pain relief. Manometric investigations of oesophageal functioning in clinical ED samples are few and have shown little evidence of dysmotility.

Discussion
Achalasia and ED share numerous clinical features including weight loss and vomiting. Pain associated with swallowing difficulties may lead to an increasingly restricted pattern of eating and food avoidance. Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/erv.2307

Is It an Eating Disorder or Achalasia or Both? A Literature Review and Diagnostic Challenges

Anorexia nervosa is a commonly considered diagnosis in young women who present with unexplained weight loss and vomiting. By contrast, achalasia is a rare disorder of the oesophagus and often goes unrecognised for many years.' The main symptom of this condition is dysphagia, but regurgitation or vomiting of food and weight loss are also common. Occasionally patients with achalasia adopt abnormal eating habits, such as self induced vomiting and avoidance of food, which can be mistaken as behavioural features of anorexia nervosa.2I We present the case histories of two adolescent girls with achalasia who had eating disorders diagnosed after initial investigations failed to find a cause for their weight loss.

https://www.bmj.com/content/bmj/305/6844/43.full.pdf

T. M. Magee

Papers

Oesophageal achalasia in adolescent women mistaken for anorexia nervosa.