Patterns of esophageal motility in patients with stable bulimia

A high prevalence of GI motility disturbances, including deranged esophageal motility, has previously been reported in patients with eating disorders; altered esophageal and gastric motility have been suggested to play an important role in these disease processes. We sought to confirm this association in an independent patient population.

We performed esophageal manometry in 12 patients with eating disorders (eight patients with bulimia and four with overlap syndromes, including both anorexia and bulimia features) and 12 sex-matched controls. All subjects completed a symptom questionnaire. Motility testing was performed in the standard fashion using a low compliance water perfusion catheter and computerized digital data capture. Coded tracings were interpreted in a blinded fashion.

All 24 studies showed normal motility patterns [95% confidence interval for abnormal esophageal motility in eating disorders patients (0, 0.27)]. Mean lower esophageal sphincter pressure was 24.4 mm Hg in patients and 21.8 in controls; all relaxed normally. Mean esophageal body contraction amplitude 3 cm above the lower esophageal sphincter was 82.6 mm Hg in patients and 84.3 in controls; waveform morphology and progression met normal criteria in all studies. Eight of 12 patients reported dysphagia, odynophagia, or both, compared with 1 of 12 controls; patients demonstrated a pattern of increased overall GI symptomatology compared to controls.

We conclude that disordered esophageal motility is uncommon among stable eating disorder outpatients with bulimic features, and that dysphagia and odynophagia are rarely associated with disordered motility in this group.