Identifying Eating Disorder Risk Factors in Those with Dysmotility Symptoms

Abstract

Purpose: Eating disorders (ED) are strongly associated with disturbing gastrointestinal sensitivity and motor physiology. Consequently, patients with EDs develop functional gastrointestinal disorders (FGIDs). The purpose of our study is to determine if patients with dysmotility symptoms have an underlying ED, if there is a specific motility disorder that is common and identify ED risk factors that should be screened for in patients with FGIDs. Methods: We performed a prospective study of patients referred to our motility lab with a variety of upper and lower gastrointestinal dysmotility symptoms. Patients were included if they had any of the following studies: esophageal manometry, anal manometry, impedance pH study, or SmartPill. Enrolled patients were screened for an underlying ED with a self-reporting questionnaire that contained ED risk factors as well as three validated diagnostic scales: 1) Eating Attitude Test (EAT); 2) DSM-IV Criteria for Anorexia Nervosa (AN) and Bulimia Nervosa (BN); 3) Eating Disorder Diagnostic Scale (EDDS) for AN, BN, and Binge Eating Disorder (BED). Significant findings were defined as the following: Eat Score ≥19, ≥3 of 4 AN DSM-IV criteria for females, ≥2 of 3 AN DSM-IV criteria for males, ≥5 of 6 BN DSM-IV criteria, ≥3 of 4 AN EDDS criteria for females, ≥2 of 3 AN EDDS criteria for males, ≥2 of 3 BN EDDS criteria, and ≥5 of 6 BED EDDS criteria. Results: One hundred patients were enrolled. Mean age was 48.4±13.7 years, 80 (80%) were female, and 47 (47%) were non-Hispanic white. Eleven (11%) were found to have a previously undiagnosed eating disorder. Of these 11 patients, 9 (81.8%) were female with a mean age of 50.5±12.5 years and 6 (54.5%) were non-Hispanic white. No difference was noted in the demographics of the two groups. ED patients were significantly more likely to report a previous or current attempt of dieting (90.9% vs. 38.2%; p=0.001) as well as compensatory behaviors (diet pill, laxatives, diuretics, self-induced vomiting, fasting; 73% vs. 13.4%; p=0.0001). Parental stress was also noted to be more common in ED patients (81.8% vs. 41.5%; p=0.02). In addition, a college education (81.8% vs. 39.3%; p=0.01) and abuse (55% vs. 22.5%; p=0.03) was significantly more frequent in the ED group. On average, ED patients were evaluated by two gastroenterologists in the outpatient setting. Discussion of neither an eating disorder nor its associated risk factors was elicited. Conclusion: Eleven (11%) of patients presenting for motility testing were found to have an ED. ED patients had a significantly increased prevalence of the following risk factors: dieting, abuse, parental stress, college education, and compensatory behaviors. These risk factors become important to ascertain in patients with dysmotility symptoms as it may indicate an underlying ED and alter the management strategy.