Anorexia nervosa in gastrointestinal practice

To characterize the demographic, psychosocial and prognostic features of patients with anorexia nervosa (AN) presenting to a gastroenterology service, and to compare them with patients presenting to an eating disorders unit.

A retrospective study set in two centres providing a local and tertiary service for gastroenterology and eating disorders. The notes of 20 consecutive patients with AN from each centre were compared. Comparison was made with a control group of 20 consecutive patients with slow transit constipation presenting to a gastroenterology service.

Patients with AN who presented to a gastroenterology service were significantly older, had often seen a large number of hospital specialists, had a spectrum of gastrointestinal complaints, suffered a substantial delay in being diagnosed, and had undergone a significantly greater number of investigations and hospital admissions than AN patients attending an eating disorders unit. The parents of AN patients presenting to a gastroenterology clinic had a greater burden of physical and psychiatric illness than the parents in either of the other groups, and also tended to have separated when the patients were under the age of 10 years. Adverse prognostic factors among AN patients presenting to a gastroenterology clinic included older age at presentation, long history, unemployment, early parental separation and a body mass index less than 17.

Patients with AN presenting to a gastroenterology service have profound psychosocial morbidity in excess of those presenting to a specialist eating disorders unit. Their diagnosis is often delayed. Early recognition and prompt referral to a specialist eating disorder unit should form the basis of management.