Digestive und prädigestive Funktionen bei Patienten mit Essstörungen

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.

Motilitätsstörung - gastrointestinale Motilität - Magenentleerung

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
• 2 Inui A, Okano H, Miyamoto M. et al . Delayed gastric emptying in bulimic patients.  Lancet. 1995;  346 1240
• 3 Stacher G. Gut function in anorexia nervosa and bulimia nervosa.  Scand J Gastroenterol. 2003;  38 573-587
• 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
• 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
• 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
• 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
• 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
• 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
• 10 Waldholtz B D, Andersen A E. Gastrointestinal symptoms in anorexia nervosa. A prospective study.  Gastroenterology. 1990;  98 1415-1419
• 11 Geracioti Jr T D , Liddle R A. Impaired cholecystokinin secretion in bulimia nervosa.  N Engl J Med. 1988;  319 683-688
• 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
• 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
• 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
• 15 Ogawa A, Mizuta I, Fukunaga T. et al . Electrogastrography abnormality in eating disorders.  Psychiatry Clin Neurosci. 2004;  58 300-310
• 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
• 17 Zipfel S, Sammet I, Rapps N. et al . Gastrointestinal disturbances in eating disorders: Clinical and neurobiological aspects.  Auton Neurosci. 2006;  129 99-106
• 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
• 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
• 20 Kamal N, Chami T, Andersen A. et al . Delayed gastrointestinal transit times in anorexia nervosa and bulimia nervosa.  Gastroenterology. 1991;  101 1320-1324
• 21 Hutson W R, Wald A. Gastric emptying in patients with bulimia nervosa and anorexia nervosa.  Am J Gastroenterol. 1990;  85 41-46
• 22 Robinson P H, Clarke M, Barrett J. Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa.  Gut. 1988;  29 458-464
• 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
• 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
• 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
• 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
• 27 Logue A W, Ophir I, Strauss K E. The acquisition of taste aversions in humans.  Behav Res Ther. 1981;  19 319-333
• 28 Kopala L C, Good K, Goldner E M. et al . Olfactory identification ability in anorexia nervosa.  J Psychiatry Neurosci. 1995;  20 283-286
• 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
• 30 Roessner V, Bleich S, Banaschewski T. et al . Olfactory deficits in anorexia nervosa.  Eur Arch Psychiatry Clin Neurosci. 2005;  255 6-9
• 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
• 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
• 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
• 34 Nederkoorn C, Smulders F T, Jansen A. Cephalic phase responses, craving and food intake in normal subjects.  Appetite. 2000;  35 45-55
• 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
• 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
• 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
• 38 Helman C A. Chewing gum is as effective as food in stimulating cephalic phase gastric secretion.  Am J Gastroenterol. 1988;  83 640-642
• 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
• 40 Katschinski M. Nutritional implications of cephalic phase gastrointestinal responses.  Appetite. 2000;  34 189-196
• 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
• 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
• 43 LeGoff D B, Leichner P, Spigelman M N. Salivary response to olfactory food stimuli in anorexics and bulimics.  Appetite. 1988;  11 15-25
• 44 Broberg D J, Bernstein I L. Cephalic insulin release in anorexic women.  Physiol Behav. 1989;  45 871-874
• 45 Moyer A, Rodin J, Cummings N. Cephalic phase insulin release in bulimia.  Int J Eat Disord. 1993;  14 331-339
• 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
• 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
• 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
• 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
• 50 Nakazato M, Murakami N, Date Y. et al . A role for ghrelin in the central regulation of feeding.  Nature. 2001;  409 194-198
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 62 Tschop M, Morrison K M. Weight loss at high altitude.  Adv Exp Med Biol. 2001;  502 237-247
• 63 Moran T H. Cholecystokinin and satiety: current perspectives.  Nutrition. 2000;  16 858-865
• 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
• 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
• 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
• 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
• 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