Essstörungen für den/die Gastroenterologen:in – was sich zu wissen lohnt

Zusammenfassung

Essstörungen sind potenziell lebensbedrohliche Erkrankungen, die mit schweren psychischen und somatischen Komorbiditäten einhergehen. Man geht davon aus, dass die Anzahl an Patienten im Nachgang der Covid-Pandemie stark ansteigen wird.

Hauptsächlich 4 Essstörungen werden im Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) und der International Classification of Diseases 11 (ICD-11) erwähnt: Anorexia nervosa (AN), Bulimia nervosa (BN), Binge eating disorder (BED) und Avoidant restrictive food intake disorder (ARFID). Viele traditionelle Annahmen bei Essstörungen sind aufgrund neuer Forschungsresultate im Wandel begriffen. Der/die Gastroenterologe/in ist normalerweise nicht die erste Anlaufstelle für Patienten/-innen mit Essstörungen. Er spielt jedoch eine zentrale Rolle, insbesondere wenn es um das Management von gastroenterologischen Komplikationen geht.

In dieser Übersicht soll der Fokus vor allem auf relevante gastroenterologische Aspekte und weniger auf die psychiatrische/psychosomatische Behandlung gelegt werden. Die Grundlagen der wichtigsten Essstörungen werden wiederholt, Möglichkeiten der Erkennung und wichtige gastroenterologische Komplikationen genannt. Die Adipositas, die oft mit Essstörungen einhergeht, ist nicht Gegenstand dieser Übersicht.

Abstract

Eating disorders are potentially life-threatening disorders that go along with severe psychiatric and somatic comorbidities. It is expected that the number of patients will dramatically increase in the post COVID-19 pandemic era.

Four main eating disorders are mentioned in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and the International Classification of Diseases 11 (ICD-11): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) und avoidant restrictive food intake disorder (ARFID). Many traditional assumptions in eating disorders are currently challenged due to recent research results. The gastroenterologist is usually not the first point of contact for patients with eating disorders. However, he is crucial, especially in the management of gastroenterologic complications of eating disorders.

Focus of the overview will be on relevant gastroenterologic aspects and less on the psychiatric treatment. Basics of the most common eating disorders will be repeated, opportunities in diagnosing an eating disorder and the most relevant gastroenterologic complications will be described. Obesity and its management, an entity that often goes along with an eating disorder, is not in the spotlight of the review.

Schlüsselwörter

Essstörung - Anorexie - Bulimie - Mikrobiom - Gut-Brain-Achse - Gastroparese - Diät

Keywords

eating disorder - anorexia - bulimia - microbiom - gut-brain-axis - gastroparesis - diet

Publication History

Received: 02 August 2022

Accepted after revision: 05 January 2023

Article published online:
08 May 2023

• Literatur

• 1 Bothe T, Walker J, Kröger C. Gender-related differences in health-care and economic costs for eating disorders: A comparative cost-development analysis for anorexia and bulimia nervosa based on anonymized claims data. Int J Eat Disord 2022; 55 (01) 6
• 2 Santonicola A, Gagliardi M, Guarino MPL. et al. Eating Disorders and Gastrointestinal Diseases. Nutrients 2019; 11 (12) 3038
• 3 Schnyder U, Milo G, Mohler-Kuo M et al. Prävalenz von Esstörungen in der Schweiz: Schlussbericht im Auftrag des BAG. 2012 https://www.bag.admin.ch
• 4 Katzman DK. The COVID-19 Pandemic and Eating Disorders: A Wake-Up Call for the Future of Eating Disorders Among Adolescents and Young Adults. J Adolesc Health 2021; 69 (04) 535-537
• 5 Lin JA, Hartman-Munick SM, Kells MR. et al. The Impact of the COVID-19 Pandemic on the Number of Adolescents/Young Adults Seeking Eating Disorder-Related Care. J Adolesc Health 2021; 69 (04) 660-663
• 6 Wässerle U, Ermer U, Habisch B. et al. “Anorexia nervosa: Steigt die Inzidenz in der Coronapandemie?” [Anorexia nervosa: does the incidence increase during the coronavirus pandemic?]. Monatsschrift Kinderheilkunde: Organ der Deutschen Gesellschaft für Kinderheilkunde 2021; 1-5
• 7 Riaz H, Jones WR, Donnellan C. et al. Knowledge and attitudes of Gastroenterologists towards Eating disorders. ARC J Psychatr 2017; 2 (04) 29-40
• 8 Fetissov SO, Hökfelt T. On the origin of eating disorders: altered signaling between gut microbiota, adaptive immunity and the brain melanocortin system regulating feeding behavior. Curr Opin Pharmacol 2019; 48: 82-91
• 9 Borgo F, Riva A, Benetti A. et al. Microbiota in anorexia nervosa: the triangle between bacterial species, metabolites and psychological tests. PLoS One 2017; 12 (06) e0179739
• 10 Claudino AM, Pike KM, Hay P et. al. The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines. BMC Med 2019; 17 (01) 93
• 11 Werlang ME, Sim LA, Lebow JR. et al. Assessing for Eating Disorders: A Primer for Gastroenterologists. Am J Gastroenterol 2021; 116 (01) 68-76
• 12 BurtonMurray H, Riddle M, Rao F. et al. Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut-brain interaction. Neurogastroenterol Motil 2021; e14258
• 13 Stanculete MF, Chiarioni G, Dumitrascu DL. et al. Disorders of the brain-gut interaction and eating disorders. World J Gastroenterol 2021; 27 (24) 3668-3681
• 14 Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020; 395: 899-911
• 15 Stewart TM, Martin CK, Williamson DA. The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted?. Int J of Environment Res and Pub Health 2022; 19 (01) 491
• 16 Ioannidis K, Chamberlain SR. Digital Hazards for Feeding and Eating: What We Know and What We Don’t. Curr Psychiatry Rep 2021; 23: 56
• 17 Xie F, Shen J, Liu T. et al. Sensation of dietary nutrients by gut taste receptors and its mechanisms. Crit Rev Food Sci Nutr 2022; 1-14
• 18 Escelsior A, Cogorno L, Sukkar SG. et al. Al. Anti-hypothalamus autoantibodies in anorexia nervosa: a possible new mechanism in neuro-physiological derangement. Eat Weight Disord 2022;
• 19 Avila JT, Park KT, Golden NH. Eating disorders in adolescents with chronic gastrointestinal and endocrine diseases. Lancet Child Adolesc Health 2019; 3 (03) 181-189
• 20 Frank GKW, Golden NH, Murray HB. Introduction to a special issue on eating disorders and gastrointestinal symptoms-The chicken or the egg?. Int J Eat Disord 2021; 54 (06) 911-912
• 21 Jafar AJN, Jafar WJJ, Everitt EK. et al. Recognising and managing eating disorders in the emergency department. Postgrad Med J 2021;
• 22 Kleppe MM, Brønstad I, Lied GA. et al. Intestinal barrier integrity in anorexia nervosa (a pilot study). Int J Eat Disord 2022;
• 23 Milos G, Antel J, Kaufmann LK. et al. Short-term metreleptin treatment of patients with anorexia nervosa: rapid on-set of beneficial cognitive, emotional, and behavioral effects. Transl Psychiatry 2020; 10 (01) 303
• 24 Smitka K, Prochazkova P, Roubalova R. et al. Current Aspects of the Role of Autoantibodies Directed Against Appetite-Regulating Hormones and the Gut Microbiome in Eating Disorders. Frontiers in endocrinology 2021; 12: 613983
• 25 Ghenciulescu A, Park RJ, Burnet PWJ. The Gut Microbiome in Anorexia Nervosa: Friend or Foe?. Front Psychiatry 2021; 11: 611677
• 26 Prochazkova P, Roubalova R, Dvorak J. et al. Microbiota, Microbial Metabolites, and Barrier Function in A Patient with Anorexia Nervosa after Fecal Microbiota Transplantation. Microorganisms 2019; 7 (09) 33
• 27 de Clercq NC, Frissen MN, Davids M. et al. Weight Gain after Fecal Microbiota Transplantation in a Patient with Recurrent Underweight following Clinical Recovery from Anorexia Nervosa. Psychother Psychosom 2019; 88 (01) 58-60
• 28 Accessed August 01, 2022 at: https://clinicaltrials.gov/ct2/show/NCT03928808
• 29 Lin JA, Woods ER, Bern EM. Common and Emergent Oral and Gastrointestinal Manifestations of Eating Disorders. Gastroenterol Hepatol (N Y) 2021; 17 (04) 157-167
• 30 Da Silva JSV, Seres DS, Sabino K. et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract 2020; 35 (02) 178-195
• 31 Reber E, Friedli N, Vasiloglou MF. et al. Management of Refeeding Syndrome in Medical Inpatients. J Clin Med 2019; 8 (12) 2202
• 32 Garber AK, Sawyer SM, Golden NH. et al. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 2016; 49 (03) 293-310
• 33 Peters JE, Basnayake C, Hebbard GS. et al. Prevalence of disordered eating in adults with gastrointestinal disorders: A systematic review. Neurogastroenterol Motil 2021; e14278
• 34 Janssen P. Can eating disorders cause functional gastrointestinal disorders?. Neurogastroenterol Motil 2010; 22: 1267-1269
• 35 McGowan A, Harer KN. Irritable Bowel Syndrome and Eating Disorders: A Burgeoning Concern in Gastrointestinal Clinics. Gastroenterol Clin North Am 2021; 50 (03) 595-610
• 36 Zipfel S, Sammet I, Rapps N. et al. Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects. Auton Neurosci 2006; 129: 99-106
• 37 Parrish CR. Beyond the scope: The Hidden Images of Eating Disorders. Nutrition Issues in Gastroenterology, Series 57. Pract Gastroenterol. 2007 https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/AndersonArticle-Dec-07.pdf
• 38 Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med 2000; 172 (03) 164-165
• 39 Jafar W, Morgan J. Anorexia nervosa and the gastrointestinal tract. Frontline Gastroenterology 2022; 13: 316-324
• 40 Herpertz S, Fichter M, Herpertz-Dahlman B. et al. S3-Leitlinie Diagnostik und Behandlung der Essstörungen. Springer. 2020 https://register.awmf.org/assets/guidelines/051-026l_S3_Essstoerung-Diagnostik-Therapie_2020-03.pdf
• 41 Zipfel S, Giel KE, Bulik CM. et al. Anorexia nervosa: aetiology, assessment, and tretment. Lancet Psychiatry 2015; 2 (12) 1099-1111
• 42 National Institut for Health and Care Excellence. Eating disorders: recognition and treatment (NG69). https://www.nice.org.uk/guidance/ng69
• 43 American Psychiatric Association. Practice guideline for treatment of patients with eating disorders (draft Feb.28, 2022): American Psychiatric Association. 2006 https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Practice-Guidelines-Eating-Disorders.pdf
• 44 Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol 2013; 6 (02) 157-167
• 45 Jeejeebhoy K. Enteral nutrition versus parenteral nutrition—the risks and benefits. Nat Rev Gastroenterol Hepatol 2007; 4: 260-265
• 46 Bendall C, Taylor NF. The effect of oral refeeding compared with nasogastric refeeding on the quality of care for patients hospitalised with an eating disorder: A systematic review. Nutr Diet 2022;
• 47 Hale MD, Logomarsino JV. The use of enteral nutrition in the treatment of eating disorders: a systematic review. Eat Weight Disord 2019; 24: 179-198
• 48 Rizzo SM, Douglas JW, Lawrence JC. Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review. Nutrition in Clinical Practice 2019; 34: 359-370
• 49 Dietrich CG, Schoppmeyer K. Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy?. World J Gastroenterol 2020; 26 (20) 2464-2471
• 50 Society for Adolescent Health and Medicine. Refeeding Hypophosphatemia in Hospitalized Adolescents With Anorexia Nervosa. J Adolesc Health 2022; 71 (04) 517-520
• 51 Madden S, Miskovic-Wheatley J, Clarke S. et al. Outcomes of a rapid refeeding protocol in Adolescent Anorexia Nervosa. J Eat Disord 2015; 3: 8
• 52 Brown CA, Sabel AL, Gaudiani JL. et al. Predictors of hypophosphatemia during refeeding of patients with severe anorexia nervosa. The International journal of eating disorders 2015; 48 (07) 898-904