Gastrointestinal alterations in anorexia nervosa - A systematic review

Objective Anorexia nervosa (AN) is an eating disorder characterized by body schema disruptions, underweight (>15% reduction of the ideal body weight or a body mass index <17.5 kg/m(2)), self-induced weight reduction, and endocrine impairments. The three latter features greatly impact on most physiological functions including the cardiovascular, skeletal, reproductive, and the gastrointestinal system, which results in an increased mortality rate in affected individuals. Especially, gastrointestinal alterations are described as particularly bothersome by patients. Methods To address the need for a better understanding of the interplay between AN and the gastrointestinal (GI) tract, a systematic data search in the databases Medline, Embase, and PsycINFO was conducted. Results Over 1,235 studies were identified, out of these, 107 appropriate articles were selected and discussed in the present review. Conclusion AN has large impact on GI alterations and symptoms; conversely, GI symptoms may also affect the manifestation and course of AN as discussed in the present review. Despite increasing data, several gaps in knowledge exist especially on the pathophysiology underlying the changes described.