Stefan Wiesnagrotzki

Pain sensitivity, alexithymia, and depression in patients with eating disorders: Are they related?

A decreased sensitivity to painful stimuli and high scores for alexithymia and depression have been observed in patients with eating disorders. We investigated the relationship between these factors in 22 patients with anorexia nervosa, 18 patients with bulimia nervosa, and 32 healthy subjects. Alexithymia was assessed using the 20-item Toronto Alexithymia Scale and depression using the Beck Depression Inventory. Patients with bulimia exhibited significantly higher thresholds to mechanically induced pain than healthy subjects. Thresholds to thermally induced pain in patients with anorexia or bulimia were similar and significantly higher than in the healthy subjects. Alexithymia and depression scores were significantly higher in anorexic and bulimic patients than in the healthy subjects. Analyses of covariance revealed that the degree of alexithymia did not influence thresholds to thermally and mechanically induced pain, whereas the severity of depression affected to some extent the threshold to thermally induced pain.

Upper gastrointestinal endoscopy findings in patients with long-standing bulimia nervosa

Bulimia nervosa, an eating disorder now recognized with increasing frequency, is receiving growing attention because of purported complications. Recent claims of a high frequency of erosions, ulceration, and bleeding in the esophagus, ascribed to repeated, self-induced vomiting, prompted us to investigate by endoscopy the upper gastrointestinal mucosa in 37 consecutive patients with long-standing bulimia nervosa. The endoscopic appearance of esophageal and gastric mucosa was normal in 23 patients. Signs of mild esophagitis observed in eight patients were not related to the duration or severity of bulimic behavior or to symptoms of gastroesophageal reflux; two of these eight patients had sliding hiatal hernias. The remaining six patients were found to have superficial mucosal erythema in the stomach or duodenum, but none showed actual erosions, ulcers, or bleeding. Our observations suggest that, in contrast to reports by others, mucosal injury consequent to chronic, self-induced vomiting in patients with bulimia nervosa is relatively infrequent and limited.

Low incidence of peripheral blood haematopoietic stem cells in patients with anorexia nervosa

Abstract Myeloid (CFU-GM) and erythroid (BFU-E) stem cells were determined in the peripheral blood (PB) from 13 female patients with severe malnutrition due to anorexia nervosa (AN). When compared to age-matched female controls, PB CFU-GM as well as BFU-E were significantly decreased in number. The reduction of the stem cell compartment indicated a more pronounced haematopoietic abnormality than was hitherto conferred from PB cell counts in AN. The clinical relevance of our finding remains to be established.

Primary anorexia nervosa: Gastric emptying and antral motor activity in 53 patients

In 53 consecutive patients with primary anorexia nervosa, gastric emptying of a semisolid meal was significantly slower than in 24 healthy subjects. Slow emptying tended to be associated with low serum potassium, low body weight, and long illness duration. Antral contraction amplitudes were lower than in healthy subjects and failed to increase postcibally, whereas contraction frequency and rhythmicity seemed unaffected. After the gastric prokinetic agent, cisapride, 8 mg intravenously administered double-blind, emptying was significantly faster than after placebo. The recognition of impaired gastric motility may be important in the management of anorexia nervosa.

Symptoms of achalasia in young women mistaken as indicating primary anorexia nervosa.

The case of a young women with dysphagia, regurgitation, and weight loss, who was diagnosed as having anorexia nervosa but in whom reevaluation showed that achalasia was causing the symptoms, is presented together with related observations. Misinterpretation of esophageal symptoms may occur not only as a consequence of inadequate history taking and of being biased by a patients emaciation, age, and gender, which leads to view certain aspects of the patients history and behavior as suggesting a pathologic attitude towards eating and body weight, but also as a consequence of a misinterpretation of the symptoms as indicative of an eating disorder by the patients themselves. In some cases a disordered attitude toward eating and body weight may develop together or coexist with achalasia. The clinical evaluation of patients with symptoms suggestive of anorexia nervosa but also of bulimia nervosa should include the taking of a thorough history regarding swallowing and vomiting in order to recognize a possible esophageal motor disorder.

Lack of association between HLA antigens and bulimia

Bulimia is an eating disorder characterized by binge eating that is associated with behavior intended to promote weight loss, such as selfinduced vomiting, laxative abuse, excessive exercise, and prolonged fasting. The lifetime prevalence of major affective disorders in bulimic patients is high (Hudson et al. 1987), and a relatively frequent occurrence of affective disorders in patients’ families has been described (Stem et al. 1984). Recently, a monozygotic twin pair with both bulimia and major depressive disorder has been reported (Brewerton et al. 1986), and a high concordance of bulimia in monozygotic twins and a low concordance in dizygotic twins has been observed (Fichter and Nogel 1988). Thus, family and twin studies suggest a genetic predisposition for affective disorders and bulimia, respectively. One method of demonstrating such a genetic factor is to show an association between a disease and the human leukocyte antigen (HLA) system (see review, Gershon et al. 1987). In patients with the classic eating disorder anorexia nervosa, a high frequency of the antigen HLA-B16 (B38 + B39) and the haplotype HLA-A26,B38 has been described by Biederman et al. (1984), however, their finding could not be reproduced by a more recent study (Kiss et al. 1988). To our knowledge, an association between HLA and bulimia has not been investigated to date.