Sileri P, Franceschilli L, De Lorenzo A, Mezzani B, Todisco P, Giorgi F, Gaspari A L, Jacoangeli F
Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy,
Tech Coloproctol. 2014 May;18(5):439-44. doi: 10.1007/s10151-013-1068-x. Epub 2013 Sep 13.
Defecatory disorders in patients with eating disorders have been overlooked. We evaluated the prevalence and type of defecatory disorders in patients with anorexia nervosa.
The aim of our questionnaire-based study was to determine the prevalence of constipation and faecal incontinence (FI) in patients with anorexia nervosa attending our dedicated eating disorders outpatient clinics and whether length of illness and low body mass index (BMI) exacerbate both constipation and FI. The Wexner constipation score (WCS), Altomare's obstructed defecation score (OD score) and the faecal incontinence severity index (FISI) were used to evaluate constipation and incontinence. A WCS ≥5, OD score ≥10 and a FISI ≥10 were considered clinically relevant.
Eighty-five patients (83 females; mean age 28 years ± 13) with anorexia nervosa (study group) and mean BMI of 16 ± 2 kg/m(2) (range 14-19 kg/m(2)) were studied. This group was compared to 57 healthy volunteers (control group) with mean BMI of 22 ± 3 kg/m(2) (range 20-27 kg/m(2)). In the study group, 79/85 (93%) patients suffered from defecatory disorders defined as at least one abnormal score, either WCS, OD score or FISI, compared to 7/57 (12%) controls (p < 0.001). Constipation (defined as WCS ≥5) was present in 70/85 (83%) patients with anorexia and in 7/57 (12%) controls (p = 0.001), while obstructed defecation syndrome (defined as OD score ≥10) was present in 71/85 (84%) patients with anorexia and 7/57 (12%) controls (p < 0.001). In patients with anorexia, the mean WCS score was 10 ± 5 standard deviation (SD) (3 ± 2 SD in controls; p < 0.001), and the mean OD score was 12 ± 4 SD (3 ± 4 SD in controls; p < 0.001). Overall, 62/85 (73%) patients with anorexia had FI defined as FISI score ≥10, and the mean FISI score in anorexia patients was 12 ± 9 SD. A combination of constipation and FI (either both WCS and FISI abnormal or both OD score and FISI abnormal) was present in 55/85 (64%) and 8/85 (9%) presented with FI alone. Moreover, all results are influenced by the severity of the disease measured by BMI and duration. The percentage of defecatory disorders rises from 75 to 100% when BMI is <18 kg/m(2) and from 60 to 75% when the duration of illness is ≥5 years (p < 0.001 and p = 0.021, respectively).
Defecatory disorders are associated with anorexia nervosa and increased with the duration and severity of the illness.
饮食失调患者的排便障碍一直被忽视。我们评估了神经性厌食症患者排便障碍的患病率及类型。
我们这项基于问卷调查的研究旨在确定在我们专门的饮食失调门诊就诊的神经性厌食症患者中便秘和大便失禁（FI）的患病率，以及病程和低体重指数（BMI）是否会加重便秘和FI。使用韦克斯纳便秘评分（WCS）、阿尔托马雷的排便梗阻评分（OD评分）和大便失禁严重程度指数（FISI）来评估便秘和失禁情况。WCS≥5、OD评分≥10以及FISI≥10被视为具有临床相关性。
研究了85例神经性厌食症患者（研究组，83名女性；平均年龄28岁±13岁），平均BMI为16±2kg/m²（范围14 - 19kg/m²）。将该组与57名健康志愿者（对照组）进行比较，对照组平均BMI为22±3kg/m²（范围20 - 27kg/m²）。在研究组中，79/85（93%）的患者存在排便障碍，定义为至少一项异常评分，即WCS、OD评分或FISI，而对照组为7/57（12%）（p < 0.001）。70/85（83%）的神经性厌食症患者存在便秘（定义为WCS≥5），对照组为7/57（12%）（p = 0.001），而71/85（84%）的神经性厌食症患者存在排便梗阻综合征（定义为OD评分≥10），对照组为7/57（12%）（p < 0.001）。神经性厌食症患者的平均WCS评分为10±5标准差（SD）（对照组为3±2 SD；p < 0.001），平均OD评分为12±4 SD（对照组为3±4 SD；p < 0.001）。总体而言，62/85（73%）的神经性厌食症患者存在定义为FISI评分≥10的FI，神经性厌食症患者的平均FISI评分为12±9 SD。55/85（64%）的患者同时存在便秘和FI（即WCS和FISI均异常或OD评分和FISI均异常），8/85（9%）的患者仅存在FI。此外，所有结果均受通过BMI和病程衡量的疾病严重程度影响。当BMI < 18kg/m²时，排便障碍的百分比从75%上升至100%；当病程≥5年时，从60%上升至75%（分别为p < 0.001和p = 0.021）。
排便障碍与神经性厌食症相关，并随疾病的病程和严重程度增加。
