McClain C J, Humphries L L, Hill K K, Nickl N J
Department of Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
J Am Coll Nutr. 1993 Aug;12(4):466-74. doi: 10.1080/07315724.1993.10718337.
Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.
神经性厌食症（AN）和神经性贪食症（BN）是潜在致命的饮食失调症，主要影响青春期女性。将饮食失调与原发性胃肠道（GI）疾病区分开来可能很困难。胃肠道疾病在饮食失调患者中很常见，超过半数患者有症状性主诉。此外，许多胃肠道疾病有时与饮食失调相似。炎症性肠病、酸相关性疾病以及诸如贲门失弛缓症等肠道动力障碍可能会模仿饮食失调。然而，通常可以通过应用饮食失调的诊断标准并进行常见的生化检查来区分这些疾病。神经性厌食症的主要特征是由于自我饥饿导致的体重显著减轻和身体形象扭曲；神经性贪食症的特征是暴饮暴食以及通过呕吐或滥用泻药自行清除摄入的食物。饮食失调中的胃肠道并发症很常见。神经性贪食症中的反复呕吐与牙齿异常、腮腺肿大以及包括代谢性碱中毒在内的电解质紊乱有关。经常可见唾液源性高淀粉酶血症，但可能导致对胰腺炎的错误诊断。尽管在饮食失调中经常出现体重减轻，但血清白蛋白、胆固醇和胡萝卜素通常是正常的。然而，锌和铜等微量元素的血清水平往往会降低，并且在重新进食期间可能会发生低磷血症。饮食失调患者经常有胃排空异常，导致腹胀、餐后饱腹感和呕吐。这通常会随着重新进食而改善，但有时需要使用促动力药物如甲氧氯普胺进行治疗。了解饮食失调的胃肠道表现以及对一种疾病伪装成另一种疾病的高度怀疑指数，对于这些患者的正确诊断和管理是必要的。
