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. 1988 Apr;29(4):458–464. doi: 10.1136/gut.29.4.458

Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa.

P H Robinson 1, M Clarke 1, J Barrett 1
PMCID: PMC1433555  PMID: 3371714

Abstract

Gastric emptying was measured using a gamma camera in 22 patients with anorexia nervosa, in 10 patients of normal or high weight with bulimia nervosa and in 10 controls. Patients with anorexia nervosa were tested (1) while underweight and selecting their own diet (10 patients); (2) underweight, but receiving an adequate diet on an inpatient unit (refeeding diet) (12 patients); and (3) under refeeding diet conditions after weight gain (eight patients). Three meals, each labelled with technetium 99m-sulphur colloid, 3.7 MBq were used: (1) a mixed solid meal containing labelled poached egg; (2) 200 ml d-glucose solution, 0.5 kcal/ml, and (3) 200 ml physiological saline. Only gastric emptying rates of the solid meal and glucose solution were significantly delayed. Gastric emptying of saline was normal. The gastric disturbance was confined to patients with anorexia nervosa selecting their own diet. Patients receiving adequate nutrition on the ward had normal gastric emptying and weight gain in this group had no significant effect on emptying. Slow emptying was observed in patients who maintained a low weight solely by food restriction as well as in patients whose anorexia nervosa was complicated by episodes of bulimia. Thus, slow gastric emptying occurred when the quantity of food reaching the duodenum was sufficiently reduced to result in severe weight loss. Moreover, abnormal gastric emptying was seen only after the two meals that contained calories and were hypertonic to plasma, either of which properties could mediate the disturbance. Gastric emptying in bulimia nervosa was normal. Slow gastric emptying could exacerbate undereating in starving patients with anorexia nervosa by enhancing satiety.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brener W., Hendrix T. R., McHugh P. R. Regulation of the gastric emptying of glucose. Gastroenterology. 1983 Jul;85(1):76–82. [PubMed] [Google Scholar]
  2. Christian P. E., Moore J. G., Sorenson J. A., Coleman R. E., Weich D. M. Effects of meal size and correction technique on gastric emptying time: studies with two tracers and opposed detectors. J Nucl Med. 1980 Sep;21(9):883–885. [PubMed] [Google Scholar]
  3. Dubois A., Gross H. A., Ebert M. H., Castell D. O. Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology. 1979 Aug;77(2):319–323. [PubMed] [Google Scholar]
  4. Garner D. M., Garfinkel P. E. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979 May;9(2):273–279. doi: 10.1017/s0033291700030762. [DOI] [PubMed] [Google Scholar]
  5. HUNT J. N. Some properties of an alimentary osmoreceptor mechanism. J Physiol. 1956 May 28;132(2):267–288. doi: 10.1113/jphysiol.1956.sp005524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Holt S., Ford M. J., Grant S., Heading R. C. Abnormal gastric emptying in primary anorexia nervosa. Br J Psychiatry. 1981 Dec;139:550–552. doi: 10.1192/bjp.139.6.550. [DOI] [PubMed] [Google Scholar]
  7. Hunt J. N., Stubbs D. F. The volume and energy content of meals as determinants of gastric emptying. J Physiol. 1975 Feb;245(1):209–225. doi: 10.1113/jphysiol.1975.sp010841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. MARKOWSKI B. Acute dilatation of the stomach. Br Med J. 1947 Jul 26;2(4516):128–130. doi: 10.1136/bmj.2.4516.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McCallum R. W., Grill B. B., Lange R., Planky M., Glass E. E., Greenfeld D. G. Definition of a gastric emptying abnormality in patients with anorexia nervosa. Dig Dis Sci. 1985 Aug;30(8):713–722. doi: 10.1007/BF01320484. [DOI] [PubMed] [Google Scholar]
  10. Minami H., McCallum R. W. The physiology and pathophysiology of gastric emptying in humans. Gastroenterology. 1984 Jun;86(6):1592–1610. [PubMed] [Google Scholar]
  11. Mitchell J. E., Pyle R. L., Miner R. A. Gastric dilatation as a complication of bulimia. Psychosomatics. 1982 Jan;23(1):96–97. doi: 10.1016/S0033-3182(82)70818-7. [DOI] [PubMed] [Google Scholar]
  12. Moore J. G., Christian P. E., Coleman R. E. Gastric emptying of varying meal weight and composition in man. Evaluation by dual liquid- and solid-phase isotopic method. Dig Dis Sci. 1981 Jan;26(1):16–22. doi: 10.1007/BF01307971. [DOI] [PubMed] [Google Scholar]
  13. Moran T. H., McHugh P. R. Cholecystokinin suppresses food intake by inhibiting gastric emptying. Am J Physiol. 1982 May;242(5):R491–R497. doi: 10.1152/ajpregu.1982.242.5.R491. [DOI] [PubMed] [Google Scholar]
  14. Russell D. M., Freedman M. L., Feiglin D. H., Jeejeebhoy K. N., Swinson R. P., Garfinkel P. E. Delayed gastric emptying and improvement with domperidone in a patient with anorexia nervosa. Am J Psychiatry. 1983 Sep;140(9):1235–1236. doi: 10.1176/ajp.140.9.1235. [DOI] [PubMed] [Google Scholar]
  15. Russell G. F. Acute dilatation of the stomach in a patient with anorexia nervosa. Br J Psychiatry. 1966 Feb;112(483):203–207. doi: 10.1192/bjp.112.483.203. [DOI] [PubMed] [Google Scholar]
  16. Russell G. Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med. 1979 Aug;9(3):429–448. doi: 10.1017/s0033291700031974. [DOI] [PubMed] [Google Scholar]
  17. Silverstone J. T., Russell G. F. Gastric "hunger" contractions in anorexia nervosa. Br J Psychiatry. 1967 Mar;113(496):257–263. doi: 10.1192/bjp.113.496.257. [DOI] [PubMed] [Google Scholar]
  18. Smith B. Effect of irritant purgatives on the myenteric plexus in man and the mouse. Gut. 1968 Apr;9(2):139–143. doi: 10.1136/gut.9.2.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Stacher G., Kiss A., Wiesnagrotzki S., Bergmann H., Höbart J., Schneider C. Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa. Gut. 1986 Oct;27(10):1120–1126. doi: 10.1136/gut.27.10.1120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wright R. A., Krinsky S., Fleeman C., Trujillo J., Teague E. Gastric emptying and obesity. Gastroenterology. 1983 Apr;84(4):747–751. [PubMed] [Google Scholar]

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