Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010-2020

Abstract

Background and aims: Gastrointestinal (GI) disorders are common in patients with eating disorders. However, the temporal relationship between GI and eating disorder symptoms has not been explored. We aimed to evaluate GI disorders among patients with eating disorders, their relative timing, and the relationship between GI diagnoses and eating disorder remission.

Methods: We conducted a retrospective analysis of patients with an eating disorder diagnosis who had a GI encounter from 2010 to 2020. GI diagnoses and timing of eating disorder onset were abstracted from chart review. Coders applied DSM-5 criteria for eating disorders at the time of GI consult to determine eating disorder remission status.

Results: Of 344 patients with an eating disorder diagnosis and GI consult, the majority (255/344, 74.2%) were diagnosed with an eating disorder prior to GI consult (preexisting eating disorder). GI diagnoses categorized as functional/motility disorders were most common among the cohort (57.3%), particularly in those with preexisting eating disorders (62.5%). 113 (44.3%) patients with preexisting eating disorders were not in remission at GI consult, which was associated with being underweight (OR 0.13, 95% CI 0.04-0.46, p < 0.001) and increasing number of GI diagnoses (OR 0.47 per diagnosis, 95% CI 0.26-0.85, p = 0.01).

Conclusions: Eating disorder symptoms precede GI consult for most patients, particularly in functional/motility disorders. As almost half of eating disorder patients are not in remission at GI consult. GI providers have an important role in screening for eating disorders. Further prospective research is needed to understand the complex relationship between eating disorders and GI symptoms.

Keywords: anorexia nervosa; avoidant/restrictive food intake disorder; bulimia nervosa; disorders of gut‐brain interaction; eating disorders; feeding and eating disorders; functional gastrointestinal disorders.

Figure 1.

Possible temporal relationships between disordered eating symptoms and gastrointestinal symptoms. A. Eating disorder symptoms and sequelae may lead to GI symptoms. B. GI symptoms may persist even when eating disorders are in remission. C. Eating disorders may present with GI symptoms before eating disorder diagnosis. D. GI symptoms or their management may lead to disordered eating. GI: gastrointestinal

Figure 2.

Cohort breakdown Note: Remission status was determined through application of DSM-5 criteria checklist (Supplemental Table 1). EDNOS: eating disorder not otherwise specified; AN: anorexia nervosa; BN: bulimia nervosa

Figure 3.

Heatmap with breakdown of GI diagnoses among (A) overall cohort of patients with a diagnosed eating disorder and GI consult, (B) patients with preexisting diagnosed eating disorder prior to GI consult and (C)patients with subsequent eating disorder diagnosed after GI consult (C) IBS: Irritable Bowel Syndrome; FD: Functional Dyspepsia; GERD: Gastroesophageal Reflux; IBD: Inflammatory Bowel Disease; NAFLD: Non-alcoholic Fatty Liver Disease Structural GI Diagnoses: Inflammatory Bowel Disease, celiac disease, non-alcoholic fatty liver disease, other structural (esophagitis, congenital cecal bascule, lap band maladjustment, parasites, helicobacter pylori, hemorrhage of the rectum and anus, polypectomy bleed, infectious gastroenteritis, small bowel obstruction, rectal prolapse, hyperthyroidism, other ascites due to malnutrition), other-liver (alcohol induced steatosis, hepatoxicity, drug induced liver injury, viral hepatitis, hepatic sarcoidosis, hepatic dilation and liver fibrosis) Functional/Motility GI Diagnoses: Irritable bowel syndrome, functional dyspepsia/gastroparesis, gastroesophageal reflux disease, constipation, other-functional/motility (dysphagia, globus sensation, esophageal spasm, achalasia, chronic nauseas, rumination syndrome, chronic abdominal pain, eating disorder, small intestinal bacterial overgrowth, sphincter of oddi dysfunction, functional diarrhea

Figure 4.

Breakdown of GI diagnoses by remission status IBS: Irritable Bowel Syndrome; FD: Functional Dyspepsia; GERD: Gastroesophageal Reflux; IBD: Inflammatory Bowel Disease; NAFLD: Non-alcoholic Fatty Liver Disease Remission status was determined by evaluating patient charts and applying the DSM-5 criteria Color ranges from green to red, with green being lower proportion of GI diagnoses and red being greater proportions