Achalasia mimicking prepubertal anorexia nervosa.
TL;DR: A 9-year-old girl presents for continuing weight loss of 10 kg over the course of 1 year and is diagnosed with esophageal achalasia, which mimicked prepubertal anorexia nervosa.
Abstract: A 9-year-old girl presents for continuing weight loss of 10kg over the course of 1 year. Medical history showed three episodes of pneumonia requiring hospital admission in the 6 months before presentation and 4 months of weekly psychotherapy for anorexia nervosa. A thorough history of eating behavior and a review of systems revealed not only typical aspects of prepubertal anorexia nervosa but also vomiting at night while asleep, difficulty drinking liquids, epigastric pain, and a frequent experience of “a lump in the throat”; these symptoms were not suggestive of a diagnosis of anorexia nervosa but rather of esophageal achalasia. The patient was transferred to the Department of Pediatrics, and a diagnosis of esophageal achalasia was made by chest x-ray and barium swallow. After dilatation and botulinum toxin application, the patient regained weight easily and was discharged in stable condition. In this case, esophageal achalasia mimicked prepubertal anorexia nervosa. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 33: 356–359, 2003.
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TL;DR: 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.
Abstract: 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.
95 citations
TL;DR: These diseases will be presented in the current review along with - where known - possible underlying mechanisms and gaps in knowledge will be highlighted.
40 citations
Journal Article•
TL;DR: Gastroparesis and chronic intestinal pseudo-obstruction are poorly characterized in children and are associated with significant morbidity as well as poor quality of life.
31 citations
TL;DR: The 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.
Abstract: 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.
23 citations
TL;DR: Increased awareness of achalasia in ED treatment settings can help facilitate detection of achalasia, thereby reducing treatment delay, and reduce treatment delay.
Abstract: 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.
15 citations
References
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TL;DR: Clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms of disordered upper gastrointestinal motor activity, and delayed gastric emptying is a frequent feature in primary anoresis nervosa and might be returned to normal with domperidone.
Abstract: Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p less than 0.01) by domperidone. Conclusions: symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.
122 citations
TL;DR: The notions of 'early-onset' and 'prepubertal' anorexia nervosa are reviewed, with particular reference to the role of the pubertal process within the condition.
Abstract: The notions of ‘early-onset’ and ‘prepubertal’ anorexia nervosa are reviewed, with particular reference to the role of the pubertal process within the condition.
A database of 650 female cases is utilized to identify a small sub-group (n= 30) who developed the condition before the menarche. Many clinical, familial, social and precipitating factors distinguish this group from post-pubertal cases as a whole, and a sub-group of post-menarcheal cases (n= 42) matched for age.
An explanation for previous inconsistent findings in‘early-onset’ and ‘prepubertal’ anorexia nervosa is advanced.
72 citations
TL;DR: The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations.
Abstract: The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations. Misinterpretation of esophageal symptoms may occur not only as a consequence of inadequate history taking and of being biased by a patient's emaciation, age, and gender, which leads to view certain aspects of the patient's history and behavior as suggesting a pathologic attitude towards eating and body weight, but also as a consequence of a misinterpretation of the symptoms as indicative of an eating disorder by the patients themselves. In some cases a disordered attitude toward eating and body weight may develop together or coexist with achalasia. The clinical evaluation of patients with symptoms suggestive of anorexia nervosa but also of bulimia nervosa should include the taking of a thorough history regarding swallowing and vomiting in order to recognize a possible esophageal motor disorder.
23 citations
TL;DR: The authors present three case studies of patients referred to Children's Hospital and Medical Center, Seattle, Washington, for evaluation of possible eating disorders, which revealed an organic basis for their weight loss.
Abstract: The authors present three case studies of patients referred to Children's Hospital and Medical Center, Seattle, Washington, for evaluation of possible eating disorders. The atypical manifestations of the cases warranted further investigation, which revealed an organic basis for their weight loss. The authors summarize the typical findings of bulimia and anorexia nervosa and discuss the clues from the case studies that mandated further evaluation.
22 citations
TL;DR: Misdiagnosis in this case could have been avoided if the symptoms of dysphagia had been elicited as part of her history, or if it had been recognized that the vomiting was involuntary and not self-induced.
Abstract: We have reported a rather extreme instance in which achalasia was misdiagnosed as a primary eating disorder Our patient spent 2 months in a psychiatric institution before the correct diagnosis was made Misdiagnosis in this case could have been avoided (1) if the symptoms of dysphagia had been elicited as part of her history, (2) if it had been recognized that the vomiting (her dominant symptom) was involuntary and not self-induced, (3) if the absence of disturbed body image had been appreciated, or (4) if it had been recognized that she did not meet accepted criteria for anorexia nervosa or bulimia Our case and others like it in the literature also illustrate that achalasia frequently remains an elusive diagnosis
14 citations