Achalasia as a complication of bulimia nervosa: A case report

Meryem O Kutuk,Gulen Guler,Ali E Tufan,Umut Kaytanli,Fevziye Toros

doi:10.4102/sajpsychiatry.v23i1.996

Abstract

Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms.Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN.Conclusion: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible.

Highlights

Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours
Long-standing BN may lead to medical complications including oesophageal rupture.[1]
The overlapping of symptoms can lead to oesophageal achalasia being misdiagnosed as BN.[6]

Summary

Objective

Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. Oesophageal achalasia can occur as a complication of BN. Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN

Conclusion

Introduction

Discussion