Sato Yasuhiro, Fukudo Shin
Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan.
Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clin J Gastroenterol. 2015 Oct;8(5):255-63. doi: 10.1007/s12328-015-0611-x. Epub 2015 Oct 26.
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.
临床上最严重的两种饮食失调症是神经性厌食症和神经性贪食症。对瘦身的追求和对肥胖的恐惧导致神经性厌食症患者要么限制食物摄入量，要么暴饮暴食后催吐（通过自我诱导呕吐和/或滥用泻药），以将体重降至远低于正常范围。对瘦身的追求导致神经性贪食症患者暴饮暴食后催吐，但体重并未减轻。饮食失调症患者会出现各种胃肠道紊乱症状，如餐后饱胀、腹胀、腹痛、胃扩张和早饱感，神经性厌食症患者有时还会出现食管动力改变。饮食失调症患者中其他常见的情况有餐后不适综合征、肠系膜上动脉综合征、肠易激综合征和功能性便秘。暴饮暴食可能导致急性胃扩张和胃穿孔，而自我诱导呕吐会导致龋齿、唾液腺肿大、胃食管反流病和电解质失衡。滥用泻药会导致脱水和电解质失衡。呕吐和/或滥用泻药会导致低钾血症，有致命心律失常风险。由于胃肠道症状/紊乱可能发展为危急状况，因此需要对饮食失调症患者进行仔细评估和强化治疗。
