Harry R. Millar

General practice consultation patterns preceding diagnosis of eating disorders

OBJECTIVE To see whether patients with eating disorders consult general practitioners more frequently than control subjects and, if so, to describe the pattern of consultation. METHOD General practitioner case record review of patients with anorexia nervosa, bulimia nervosa, and partial syndromes referred to a specialist eating disorder service. RESULTS Seventy-eight of 100 case records were available for analysis. Eating disorder patients consulted significantly more frequently than controls over 5 years prior to the diagnosis of the eating disorder. They presented to the general practitioners with a variety of symptoms including psychological, gastrointestinal, and gynecological complaints. DISCUSSION The findings suggest that methods could be developed to enable earlier diagnosis of eating disorders in general practice. This will enable the earlier application of effective treatments with the prospect of improved outcome.

Hyperamylasemia in bulimia nervosa and hyperemesis gravidarum.

OBJECTIVES The exact causes of hyperamylasemia detected in bulimia nervosa are unknown but it is presumed to be due either to repeated binging or to vomiting. This study set out to investigate the importance of vomiting in producing the raised serum amylase and to clarify whether the amylase in pancreatic or salivary. METHODS Patients suffering from hyperemesis gravidarum who were repeatedly vomiting in pregnancy but not binge eating had their total serum and pancreatic amylase measured. Bulimic patients and a control sample of nonvomiting pregnant women were similarly studied. An assessment of the frequency and duration of vomiting and binging was also made. RESULTS Results show 45% (5) of bulimic patients had raised serum amylase, but none had a raised pancreatic amylase. Twenty-four percent (7) of the hyperemetic patients also had a raised serum amylase level, all with a normal pancreatic amylase level. None of the nonvomiting pregnant patients had a raised amylase. DISCUSSION Of patients with hyperemesis gravidarum who repeatedly vomit but do not binge, a significant number had raised amylase. This suggests that it is the vomiting rather than the binge behavior that increases amylase in bulimic patients. This increased amylase probably comes from the salivary gland.