Anxiety related to abdominal gastrointestinal symptoms may lead to eating disorders among patients with chronic constipation, according to study results.
Helen S. Murray, MS, of the department of psychology at Massachusetts General Hospital, and colleagues wrote that individuals with eating disorders regularly complain about GI problems, including constipation and its related symptoms.
“Preliminary studies have shown that average gastrointestinal symptom scores can significantly decrease pre- to post-treatment for individuals treated for eating disorders, suggesting that eating disorder pathology likely contributes to gastrointestinal symptom maintenance,” they wrote. “Although how eating disorder pathology and constipation symptoms relate is not well tested, anxiety may be an important factor and has been hypothesized as a mediator by others.”
To further explore this relationship, researchers analyzed data from 279 patients with chronic constipation who visited a tertiary care center between 2017 and 2018. Patients completed standardized psychometric assessment, including assessments on constipation symptoms, hospital anxiety and depression scale, and visceral sensitivity index. They also underwent anorectal manometry.
Murray and colleagues used the eating attitudes test-26 to assess patients for potential eating disorders and defined a clinically significant eating disorder as a score of at least 20.
Researchers identified 53 participants with an eating disorder (19%). The presence of an eating disorder was associated with greater general anxiety scores based on the hospital anxiety and depression scale (OR = 1.2; 95% CI, 1.05–1.38) and greater GI-specific anxiety scores based on the visceral sensitivity index (OR = 1.06; 95% CI, 1.03–1.09).
GI-specific anxiety fully mediated the relationship between the severity of eating disorder pathology and constipation, according to the investigators.
“We believe our findings have significant implications for clinical practice, including the possibility that clinicians screen chronic constipation patients for eating disorder pathology — most notably with patients who report abdominal-specific constipation symptoms,” they wrote. “In addition, likelihood of having significant [eating disorder] pathology was significantly associated with both higher scores on general and gastrointestinal-specific anxiety measures, making screening especially relevant with patients who describe worries/fears around gastrointestinal sensations.” – by Alex Young
Disclosure: Murray reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.