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Z Gastroenterol 2007; 45(3): 273-280
DOI: 10.1055/s-2006-927383
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Digestive und prädigestive Funktionen bei Patienten mit Essstörungen

Digestive and Predigestive Functions in Patients with Eating DisordersN. Rapps1 , P. Enck1 , U. Martens1 , I. Sammet1 , M. Teufel1 , B. Otto2 , S. Zipfel1
  • 1Medizinische Universitätsklinik, Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
  • 2Innere Medizin, Medizinische Klinik Innenstadt, Ludwig-Maximilians-Universität, München
Further Information

Publication History

Manuskript eingetroffen: 4.6.2006

Manuskript akzeptiert: 15.12.2006

Publication Date:
15 March 2007 (online)

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Zusammenfassung

Patientinnen mit Essstörungen (Anorexia nervosa, AN; Bulimia nervosa, BN) weisen häufig gastrointestinale Symptome und veränderte gastrointestinale Funktionen, insbesondere eine verlängerte Magenentleerung, auf. Diese Symptome gelten bislang als Sekundärphänomene der Mangel- und Fehlernährung, sowie als Folge von Erbrechen oder der Einnahme von Laxantien. Im Verlauf einer erfolgreichen Behandlung kommt es zur signifikanten Abnahme gastrointestinaler Symptome. Es gibt eine Reihe von Belegen, dass auch prädigestive Funktionen (Geruch, Geschmack, cephale Phase der Nahrungsaufnahme) und die hormonelle Regulation der Digestion verändert sind. Dies verweist auf die Möglichkeit, dass bei einer Teilpopulation der Patientinnen mit AN und BN die gestörten digestiven und prädigestiven Funktionen auch mitverantwortlich für das Entstehen oder die Aufrechterhaltung einer Essstörung (ES) sein könnten. Die bisherige Literatur wird unter dieser Prämisse diskutiert und analysiert.

Abstract

Patients with eating disorders (anorexia nervosa, AN; bulimia nervosa, BN) frequently exhibit gastrointestinal symptoms and altered gastrointestinal functions, especially delayed gastric emptying. These symptoms are regarded as secondary to the disordered eating behaviour, vomiting or laxative misuse. They often improve during successful therapy. There are, however, studies showing that in addition predigestive functions (smell, taste, cephalic phase of digestion) and the hormonal regulation of digestion may be changed in eating disorders. This underlines the possibility that, in a subpopulation of patients with AN and BN, the disturbed digestive and predigestive functions may be involved in the pathogenesis of the eating disorders. The current literature is analysed and summarised in this context.

Schlüsselwörter

Motilitätsstörung - gastrointestinale Motilität - Magenentleerung

Key words

Motility disorders - gastrointestinal motility - gastric emptying

Literatur

  • 1 Hadley S J, Walsh B T. Gastrointestinal disturbances in anorexia nervosa and bulimia nervosa.  Curr Drug Targets CNS Neurol Disord. 2003;  2 1-9
    Google Scholar
  • 2 Inui A, Okano H, Miyamoto M. et al . Delayed gastric emptying in bulimic patients.  Lancet. 1995;  346 1240
    Google Scholar
  • 3 Stacher G. Gut function in anorexia nervosa and bulimia nervosa.  Scand J Gastroenterol. 2003;  38 573-587
    Google Scholar
  • 4 Perkins S J, Keville S, Schmidt U. et al . Eating disorders and irritable bowel syndrome: is there a link?.  J Psychosom Res. 2005;  59 57-64
    Google Scholar
  • 5 Abell T L, Malagelada J R, Lucas A R. et al . Gastric electromechanical and neurohormonal function in anorexia nervosa.  Gastroenterology. 1987;  93 958-965
    Google Scholar
  • 6 Stacher G, Kiss A, Wiesnagrotzki S. et al . Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa.  Gut. 1986;  27 1120-1126
    Google Scholar
  • 7 Ravelli A M, Helps B A, Devane S P. et al . Normal gastric antral myoelectrical activity in early onset anorexia nervosa.  Arch Dis Child. 1993;  69 342-346
    Google Scholar
  • 8 Benini L, Todesco T, Dalle G rave R. et al . Gastric emptying in patients with restricting and binge/purging subtypes of anorexia nervosa.  Am J Gastroenterol. 2004;  99 1448-1454
    Google Scholar
  • 9 Dubois A, Gross H A, Ebert M H. et al . Altered gastric emptying and secretion in primary anorexia nervosa.  Gastroenterology. 1979;  77 319-323
    Google Scholar
  • 10 Waldholtz B D, Andersen A E. Gastrointestinal symptoms in anorexia nervosa. A prospective study.  Gastroenterology. 1990;  98 1415-1419
    Google Scholar
  • 11 Geracioti Jr T D , Liddle R A. Impaired cholecystokinin secretion in bulimia nervosa.  N Engl J Med. 1988;  319 683-688
    Google Scholar
  • 12 Szmukler G I, Young G P, Lichtenstein M. et al . A serial study of gastric emptying in anorexia nervosa and bulimia.  Aust N Z J Med. 1990;  20 220-225
    Google Scholar
  • 13 Boyd C, Abraham S, Kellow J. Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders.  Scand J Gastroenterol. 2005;  40 929-935
    Google Scholar
  • 14 Buchman A L, Ament M E, Weiner M. et al . Reversal of megaduodenum and duodenal dysmotility associated with improvement in nutritional status in primary anorexia nervosa.  Dig Dis Sci. 1994;  39 433-440
    Google Scholar
  • 15 Ogawa A, Mizuta I, Fukunaga T. et al . Electrogastrography abnormality in eating disorders.  Psychiatry Clin Neurosci. 2004;  58 300-310
    Google Scholar
  • 16 Diamanti A, Bracci F, Gambarara M. et al . Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders.  J Pediatr Gastroenterol Nutr. 2003;  37 35-41
    Google Scholar
  • 17 Zipfel S, Sammet I, Rapps N. et al . Gastrointestinal disturbances in eating disorders: Clinical and neurobiological aspects.  Auton Neurosci. 2006;  129 99-106
    Google Scholar
  • 18 Friederich H C, Schild S, Schellberg D. et al . Cardiac parasympathetic regulation in obese women with binge eating disorder.  Int J Obes (Lond). 2006;  30 534-542
    Google Scholar
  • 19 Chami T N, Andersen A E, Crowell M D. et al . Gastrointestinal symptoms in bulimia nervosa: effects of treatment.  Am J Gastroenterol. 1995;  90 88-92
    Google Scholar
  • 20 Kamal N, Chami T, Andersen A. et al . Delayed gastrointestinal transit times in anorexia nervosa and bulimia nervosa.  Gastroenterology. 1991;  101 1320-1324
    Google Scholar
  • 21 Hutson W R, Wald A. Gastric emptying in patients with bulimia nervosa and anorexia nervosa.  Am J Gastroenterol. 1990;  85 41-46
    Google Scholar
  • 22 Robinson P H, Clarke M, Barrett J. Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa.  Gut. 1988;  29 458-464
    Google Scholar
  • 23 Le Floch J P, Le Lievre G, Labroue M. et al . Smell dysfunction and related factors in diabetic patients.  Diabetes Care. 1993;  16 934-937
    Google Scholar
  • 24 Daum R F, Sekinger B, Kobal G. et al . Olfactory testing with „sniffin’ sticks” for clinical diagnosis of Parkinson disease.  Nervenarzt. 2000;  71 643-650
    Google Scholar
  • 25 Kopala L C, Good K P, Honer W G. Olfactory hallucinations and olfactory identification ability in patients with schizophrenia and other psychiatric disorders.  Schizophr Res. 1994;  12 205-211
    Google Scholar
  • 26 Berteretche M V, Dalix A M, d’Ornano A M. et al . Decreased taste sensitivity in cancer patients under chemotherapy.  Support Care Cancer. 2004;  12 571-576
    Google Scholar
  • 27 Logue A W, Ophir I, Strauss K E. The acquisition of taste aversions in humans.  Behav Res Ther. 1981;  19 319-333
    Google Scholar
  • 28 Kopala L C, Good K, Goldner E M. et al . Olfactory identification ability in anorexia nervosa.  J Psychiatry Neurosci. 1995;  20 283-286
    Google Scholar
  • 29 Fedoroff I C, Stoner S A, Andersen A E. et al . Olfactory dysfunction in anorexia and bulimia nervosa.  Int J Eat Disord. 1995;  18 71-77
    Google Scholar
  • 30 Roessner V, Bleich S, Banaschewski T. et al . Olfactory deficits in anorexia nervosa.  Eur Arch Psychiatry Clin Neurosci. 2005;  255 6-9
    Google Scholar
  • 31 Da Silva M S, Zimmerman P M, Meguid M M. et al . Anorexia in space and possible etiologies: an overview.  Nutrition. 2002;  18 805-813
    Google Scholar
  • 32 Olabi A A, Lawless H T, Hunter J B. et al . The effect of microgravity and space flight on the chemical senses.  J Food Sci. 2002;  67 468-478
    Google Scholar
  • 33 Vickers Z M, Rice B L, Rose M S. et al . Simulated microgravity [bed rest] has little influence on taste, odor or trigeminal sensitivity.  J Sens Stud. 2001;  16 23-32
    Google Scholar
  • 34 Nederkoorn C, Smulders F T, Jansen A. Cephalic phase responses, craving and food intake in normal subjects.  Appetite. 2000;  35 45-55
    Google Scholar
  • 35 Balaji N S, Crookes P F, Banki F. et al . A safe and noninvasive test for vagal integrity revisited.  Arch Surg. 2002;  137 954-958; discussion 958 - 959
    Google Scholar
  • 36 Richardson C T, Feldman M. Salivary response to food in humans and its effect on gastric acid secretion.  Am J Physiol. 1986;  250 G85-91
    Google Scholar
  • 37 Feldman M, Richardson C T. Role of thought, sight, smell, and taste of food in the cephalic phase of gastric acid secretion in humans.  Gastroenterology. 1986;  90 428-433
    Google Scholar
  • 38 Helman C A. Chewing gum is as effective as food in stimulating cephalic phase gastric secretion.  Am J Gastroenterol. 1988;  83 640-642
    Google Scholar
  • 39 Chen J D, Pan J, Orr W C. Role of sham feeding in postprandial changes of gastric myoelectrical activity.  Dig Dis Sci. 1996;  41 1706-1712
    Google Scholar
  • 40 Katschinski M. Nutritional implications of cephalic phase gastrointestinal responses.  Appetite. 2000;  34 189-196
    Google Scholar
  • 41 Glasbrenner B, Bruckel J, Gritzmann R. et al . Cephalic phase of pancreatic polypeptide release: a valid test of autonomic neuropathy in diabetics?.  Diabetes Res Clin Pract. 1995;  30 117-123
    Google Scholar
  • 42 Blinder B J, Hagman J. Serum salivary isoamylase levels in patients with anorexia nervosa, bulimia or bulimia nervosa.  Hillside J Clin Psychiatry. 1986;  8 152-163
    Google Scholar
  • 43 LeGoff D B, Leichner P, Spigelman M N. Salivary response to olfactory food stimuli in anorexics and bulimics.  Appetite. 1988;  11 15-25
    Google Scholar
  • 44 Broberg D J, Bernstein I L. Cephalic insulin release in anorexic women.  Physiol Behav. 1989;  45 871-874
    Google Scholar
  • 45 Moyer A, Rodin J, Cummings N. Cephalic phase insulin release in bulimia.  Int J Eat Disord. 1993;  14 331-339
    Google Scholar
  • 46 Karhunen L J, Lappalainen R I, Tammela L. et al . Subjective and physiological cephalic phase responses to food in obese binge-eating women.  Int J Eat Disord. 1997;  21 321-328
    Google Scholar
  • 47 Uher R, Murphy T, Brammer M J. et al . Medial prefrontal cortex activity associated with symptom provocation in eating disorders.  Am J Psychiatry. 2004;  161 1238-1246
    Google Scholar
  • 48 Naruo T, Nakabeppu Y, Sagiyama K. et al . Characteristic regional cerebral blood flow patterns in anorexia nervosa patients with binge/purge behavior.  Am J Psychiatry. 2000;  157 1520-1522
    Google Scholar
  • 49 Stern R M, Jokerst M D, Levine M E. et al . The stomach’s response to unappetizing food: cephalic-vagal effects on gastric myoelectric activity.  Neurogastroenterol Motil. 2001;  13 151-154
    Google Scholar
  • 50 Nakazato M, Murakami N, Date Y. et al . A role for ghrelin in the central regulation of feeding.  Nature. 2001;  409 194-198
    Google Scholar
  • 51 Tschop M, Wawarta R, Riepl R L. et al . Post-prandial decrease of circulating human ghrelin levels.  J Endocrinol Invest. 2001;  24 RC19-RC21
    Google Scholar
  • 52 Date Y, Kojima M, Hosoda H. et al . Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans.  Endocrinology. 2000;  141 4255-4261
    Google Scholar
  • 53 Cummings D E, Purnell J Q, Frayo R S. et al . A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans.  Diabetes. 2001;  50 1714-1719
    Google Scholar
  • 54 Arosio M, Ronchi C L, Beck-Peccoz P. et al . Effects of modified sham feeding on ghrelin levels in healthy human subjects.  J Clin Endocrinol Metab. 2004;  89 5101-5104
    Google Scholar
  • 55 Heath R B, Jones R, Frayn K N. et al . Vagal stimulation exaggerates the inhibitory ghrelin response to oral fat in humans.  J Endocrinol. 2004;  180 273-281
    Google Scholar
  • 56 Horvath T L, Diano S, Sotonyi P. et al . Minireview: ghrelin and the regulation of energy balance - a hypothalamic perspective.  Endocrinology. 2001;  142 4163-4169
    Google Scholar
  • 57 Arosio M, Ronchi C L, Gebbia C. et al . Stimulatory effects of ghrelin on circulating somatostatin and pancreatic polypeptide levels.  J Clin Endocrinol Metab. 2003;  88 701-704
    Google Scholar
  • 58 Zhang W, Chen M, Chen X. et al . Inhibition of pancreatic protein secretion by ghrelin in the rat.  J Physiol. 2001;  537 231-236
    Google Scholar
  • 59 Otto B, Cuntz U, Fruehauf E. et al . Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa.  Eur J Endocrinol. 2001;  145 669-673
    Google Scholar
  • 60 Otto B, Tschop M, Fruhauf E. et al . Postprandial ghrelin release in anorectic patients before and after weight gain.  Psychoneuroendocrinology. 2005;  30 577-581
    Google Scholar
  • 61 Otto B, Tschop M, Cuntz U. Letter to the Editor: Similar fasting ghrelin levels in binge eating/purging anorexia nervosa and restrictive anorexia nervosa.  Psychoneuroendocrinology. 2004;  29 692-693
    Google Scholar
  • 62 Tschop M, Morrison K M. Weight loss at high altitude.  Adv Exp Med Biol. 2001;  502 237-247
    Google Scholar
  • 63 Moran T H. Cholecystokinin and satiety: current perspectives.  Nutrition. 2000;  16 858-865
    Google Scholar
  • 64 Tang T N, Toner B B, Stuckless N. et al . Features of eating disorders in patients with irritable bowel syndrome.  J Psychosom Res. 1998;  45 171-178
    Google Scholar
  • 65 Faris P L, Kim S W, Meller W H. et al . Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomised, double-blind trial.  Lancet. 2000;  355 792-797
    Google Scholar
  • 66 Faris P L, Kim S W, Meller W H. et al . Effect of ondansetron, a 5-HT3 receptor antagonist, on the dynamic association between bulimic behaviors and pain thresholds.  Pain. 1998;  77 297-303
    Google Scholar
  • 67 Raymond N C, Faris P L, Thuras P D. et al . Elevated pain threshold in anorexia nervosa subjects.  Biol Psychiatry. 1999;  45 1389-1392
    Google Scholar
  • 68 Faris P L, Eckert E D, Kim S W. et al . Evidence for a vagal pathophysiology for bulimia nervosa and the accompanying depressive symptoms.  J Affect Disord. 2006;  92 79-90
    Google Scholar

Prof. Dr. Paul Enck

Universitätsklinikum Tübingen, Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie

Osianderstr. 5

72076 Tübingen

Phone: ++49/70 71/2 98 67 06

Fax: ++49/70 71/29 51 42

Email: paul.enck@uni-tuebingen.de

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