Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment

Caroline Riedlinger; Nazar Mazurak; Norbert Schäffeler; Andreas Stengel; Katrin Elisabeth Giel; Stephan Zipfel; Paul Enck; Isabelle Mack

doi:10.3389/fpsyt.2022.962837

Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment

Front Psychiatry. 2022 Aug 18:13:962837. doi: 10.3389/fpsyt.2022.962837. eCollection 2022.

Authors

Caroline Riedlinger^{1

2}, Nazar Mazurak^{1

2}, Norbert Schäffeler¹, Andreas Stengel^{1

2

3}, Katrin Elisabeth Giel^{1

2}, Stephan Zipfel^{1

2}, Paul Enck^{1

2}, Isabelle Mack^{1

2}

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
² Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
³ Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.

Abstract

Background: In patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN.

Methods: In weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models.

Results: Abdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation.

Conclusions: Informing patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.

Keywords: abdominal pain; anorexia nervosa; constipation; eating disorders; gastrointestinal complaints; indigestion.