World Digestive Health Day WDHD – May 29, 2016 EATING DISORDERS AND THE GI TRACT: DEFINITION, RECOGNITION, THE ROLE OF THE PSYCHOLOGIST IN CARE, continued and instead experience a sense of lacking control during binge-eating episodes. BN has a 12-month prevalence of 1.0- 1.5% and is also more common in females.1 In contrast, BED and ARFIDs are more focused on the food or the process of eating itself. In BED, episodes of binge-eating occur with a sense of lacking control, however, there are no compensatory methods to control weight. Instead, after eating large amounts without feeling hungry, an individual may conceal symptoms, feel guilty, depressed, or disgusted with themselves. The BED group may also be under recognized in part because they do not fit the young female stereotype. BED has a 12-month prevalence of 1.6% in females and 0.8% in males. ARFIDs involve falling below energy and nutritional needs due to a lack of interest in eating, dislike for the sensation of food, or concern for possible consequences of eating (e.g., choking or vomiting).1 COMMON GI COMPLAINTS REPORTED BY INDIVIDUALS WITH EDS It is very common for individuals with EDs to experience GI symptoms. For example, in BN compensatory methods to control weight after a binge-eating episode can include selfinduced vomiting or laxative abuse. The use of these methods can be problematic for GI health and lead to a variety of complications, such as dental, esophageal, motility, or impaired gastric emptying.2 Conditions such as AN are often associated with abnormal GI sensations and motility, however some of these may be reversible with weight gain and others may relate to underlying psychiatric manifestations, possibly a common cause (such as previous abuse). Individuals with EDs who attend a GI clinic prior to ED treatment request more tests and have more hospital admissions than other GI patients or ED patients who first attend ED treatment.3 Additionally, individuals with functional gastrointestinal disorders (FGIDs) are significantly more likely to have a history of eating disorders than a gallstone disease comparison group, indicating that coexisting GI symptoms may persist after the ED has resolved.4 Both upper and lower GI symptoms are common among individuals with EDs,2 and the eating disorder itself may be ‘hidden’ by the GI symptoms. Consequently, awareness of EDs in gastroenterologists is important as patients with EDs may approach them before approaching other professionals, such as a psychologist. RECOGNITION OF EDS IN GI PRACTICE: Individuals with EDs have been found to frequently approach practitioners regarding physical GI symptoms prior to talking about EDs.2 A recent systematic review (based on four studies with total of 691 GI patients) suggests that disordered eating patterns occur in around 23% of GI patients.5 Gastroenterologists can help patients with EDs by being aware of EDs and routinely screening patients for these, as some symptoms may become salient during psychological distress.4 Establishing a multi-disciplinary team of healthcare professionals (such as physicians, registered dieticians, psychologists, and psychiatrists) may also be helpful.6 This can help patients with EDs to receive support for their EDs and avoid unnecessary and potentially dangerous tests and/or hospitalization, whilst having their FGID symptoms and also the physical complications of their EDs managed appropriately. SIGNS TO HELP IDENTIFY GI PATIENTS WITH EDS • Younger female demographic • Psychological distress or comorbid mental disorder • Concerned with size or shape of body • Underweight or over-eating • Excessive focus on foods and engagement with restrictive eating patterns based upon beliefs relating to foods (e.g., most healthy/pure) • Erosion of tooth enamel • Reflux symptoms • Extensive investigations required to identify GI issue • Functional motility disorders • Score on an ED screening survey TREATMENT OF EDS The latest guidelines from the American Psychiatric Association6 and the UK based National Institute for Clinical Excellence7 provide detailed and evidence-based recommendations in the treatment of EDs. The first steps in the treatment for AN and BN are to restore a healthy weight, reduce or eliminate binge-eating or purging, and to treat any physical complications of the disorders.6 Focus should also include goal setting to restore a healthy eating pattern and the provision of nutritional information on how to achieve this. Additionally, therapy is recommended to reassess unhelpful thinking, treat comorbidity, build family support, and to prevent relapse. Patients are often treated in the outpatient setting, and may benefit 42 WGO Handbook on DIET AND THE GUT World Digestive Health Day WDHD May 29, 2016
WGO Handbook on Diet and the Gut_2016_Final
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