Effectiveness of biliopancreatic diversion in the patients with bulimia nervosa

Bulimia nervosa (BN) is an eating disorder, characterized by consumption of huge amounts of food during discrete periods. Unlike patients with binge-eating disorder (BED), patients with BN demonstrate elements of compensatory "purging" behavior to prevent weight gain and obesity: i.e. self-induced vomiting, use of laxatives and enemas. These habits may prevent patients from attaining morbid obesity (MO), but may seriously affect life-style and become an excruciating, sometimes life-threatening condition.

6 of 108 patients (5.6%) who underwent BPD in our clinic (laparoscopic Scopinaro BPD - 1, open BPD/DS - 4, Lap. BPD/DS - 1) suffered from BN preoperatively. Their preoperative weight was 68-117 kg and BMI 27.6-41.9 kg/m(2). 4 of 6 patients had BMI <40 kg/m(2) before BPD but were MO in the past. The patient with the lowest weight had repeated gastroesophageal bleeding during self-induced vomiting. 3 of the 6 patients had previously failed intragastric balloon or Lap-Band.

All 6 patients were cured or significantly improved of bulimic symptoms soon after BPD. Weight loss was very good and never reached an undesirably low level. Patient satisfaction was high.

Severe BN may be considered as a latent and potentially malignant MO. BPD (or BPD/DS) may be an effective solution for some patients with severe BN, as a final decision after unsuccessful organized conservative attempts. All candidates for bariatric surgery should be screened for BN, because it may influence choice of procedure in favor to BPD or BPD/DS.