Symptoms of achalasia in young women mistaken as indicating primary anorexia nervosa.
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.
Citations
More filters
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: It is suggested that PDPs do not appear to have an eating disorder, but that they report clinically significant levels of psychological distress, particularly anxiety.
Abstract: Patients who report dysphagia, but have no detectable physical defect, have often been diagnosed as having an eating disorder. This diagnosis was evaluated by administering the Eating Disorders Inventory-2 (EDI-2) and a measure of distress, the Symptom Checklist-90 (SCL-90R), to a sample of 21 adult psychogenic dysphagia patients (PDPs). Their EDI-2 responses were then compared with samples of anorexics, college men, and college women, and their SCL-90R responses were compared with published data of patients with dysphagia due to a motility disorder, an obstruction, or neither. Relative to the anorexics, the PDPs scored significantly lower on all EDI-2 dimensions except maturity fears. For the SCL-90R, PDPs scored significantly higher on the interpersonal sensitivity, depression, anxiety, and general severity index than did the dysphagia comparison groups. Moreover, PDP scores on the anxiety and interpersonal sensitivity dimensions were indicative of clinically significant distress. These findings suggest that PDPs do not appear to have an eating disorder, but that they report clinically significant levels of psychological distress, particularly anxiety.
35 citations
TL;DR: The clinical, histopathological and genetic findings of six patients from three families with gastrointestinal manifestations of mitochondrial disease are described and two important but poorly understood aspects, the clinical and the genetic are highlighted.
29 citations
TL;DR: 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 are presented.
Abstract: 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.
26 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
References
More filters
TL;DR: The fact that psychiatric illness is associated with a specific cluster of esophageal contraction abnormalities may provide a basis for further investigation of the relation between emotional disturbances and disorders of gastrointestinal motility.
Abstract: Over a six-month period 50 patients referred for clinical esophageal manometry were independently evaluated for psychiatric diagnoses to determine whether there was any association between psychiatric illness and esophageal motility disorders. The manometric studies were blindly classified according to findings in the esophageal body. Twenty-five patients were classified as having one or more of the following contraction abnormalities: an increase in mean wave amplitude, an increase in mean wave duration, an increased frequency of abnormal motor responses, or the presence of triple-peaked waves. Psychiatric diagnoses were made in 21 (84 per cent) of the 25 patients but in only 4 (31 per cent) of the 13 patients with normal manometric patterns (P less than 0.005) and 4 (33 per cent) of the 12 with other manometric abnormalities (P less than 0.01). The fact that psychiatric illness is associated with a specific cluster of esophageal contraction abnormalities may provide a basis for further investigation of the relation between emotional disturbances and disorders of gastrointestinal motility.
266 citations
Book•
[...]
01 Jan 1978
225 citations
"Symptoms of achalasia in young wome..." refers background in this paper
...The driving motive for patients affected by this disorder traditionally is seen as a relentless pursuit of thinness, a phobic avoidance of being fat [2]....
[...]
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
"Symptoms of achalasia in young wome..." refers background in this paper
...Although the history will lead to a strong suspicion of the correct diagnosis in the majority of cases, the clinical picture may mislead, as reported previously [1], the physician to assume- a behavioral disturbance or an eating disorder such as primary anorexia nervosa (PAN)....
[...]
TL;DR: The incidence of achalasia in the Nottingham area between 1966 and 1983 has been examined using hospital diagnostic indices supplemented by personal endoscopy files and the duration of dysphagia before diagnosis was no less with greater availability of manometry and endoscope.
Abstract: SUMMARY The incidence of achalasia in the Nottingham area between 1966 and 1983 has been examined using hospital diagnostic indices supplemented by personal endoscopy files. All patients were traced and the date of death recorded where relevant. A total of 53 cases was confirmed and the incidence was 0.51 cases/105/year and the prevalence on 31 December 1983, was 8/105. The age-specific incidence of the disease increased in older groups. The duration of dysphagia before diagnosis was no less with greater availability of manometry and endosc
70 citations
"Symptoms of achalasia in young wome..." refers background in this paper
...For example, a study carried out in the Nottingham area of the English Midlands estimated a prevalence of achalasia of 8:100,000 population [5]....
[...]
TL;DR: It is concluded that consideration should be given to psychiatric illness as well as to neuropathy when interpreting manometric features suggestive of autonomic dysfunction in diabetic patients.
49 citations
"Symptoms of achalasia in young wome..." refers background in this paper
...tween esophageal contraction abnormalities and criteria-defined psychiatric illness in diabetic [8]...
[...]