Disorders of the brain-gut interaction and eating disorders

Table 3 Studies analyzing the association between functional constipation and eating disorders

Ref.	Aims	Study population	Assessment instruments	Results and conclusions
Chun et al[47], 1997	Colorectal function measuring colonic transit and anorectal function in AN with constipation during treatment with a refeeding program	Prospective study 13 AN females; 20 age-matched, female HC	Radiopaque marker technique; anorectal manometry	Colonic transit is normal/returns to normal in the majority of AN patients once they are consuming a balanced weight gain or weight maintenance diet for at least 3 wk
Sileri et al[48], 2014	Prevalence and type of defecatory disorders in AN patients	85 patients (83 female and 2 male); mean age 28 ± 13 yr; BMI 16 ± 2 kg/m2; 57 HC, BMI 22 ± 3 kg/m2	WCS, OD score, FISI	All results influenced by the severity of the disease (BMI; duration). The percentage of defecatory disorders rises from 75 to 100% when BMI is < 18 kg/m2 and from 60% to 75% when the duration of illness is ≥ 5 yr (P < 0.001 and P = 0.021)
Chiarioni et al[49], 2000	Anorectal and colonic function in AN patients complaining of chronic constipation	12 AN female (age 19-29 yr) chronic constipation. 12 female HC	Anorectal manometry; radiopaque technique; test of rectal sensation	AN patients: anorectal motor abnormalities (slow colonic tranzit time, pelvic floor dysfunction)
Boyd et al[50], 2005	Prevalence and type of FGIDs in AN, BN and EDNOS patients; relationships between psychological features, eating-disordered attitudes and behaviours, demographic characteristics and the type and number of FGIDs	101 consecutive female AN (n = 45, 44%), EDNOS (n = 34, 34%), BN (n = 22, 22%). Mean age 21 yr	Rome II modular questionnaire GI, ENS, BDI, STAI, BSI somatization subscale, EEE-C, version 4, EDI-2, EAT	52% IBS (constipation-predominant 22%, diarrhoea-predominant 6%, alternating 24%), FH (51%), FAB (31%), FC (24%), FDys (23%), FAno (22%). 52% of patients exhibited 3 or more coexistent FGID diagnoses. Psychological variables (somatization, neuroticism, state and trait anxiety), age and binge eating were significant predictors of specific, and > 3 coexistent FGIDs
Murray et al[51], 2020	Frequency of and relation between EDs and constipation in patients with chronic constipation referred for anorectal manometry	279 patients with chronic constipation (79.2% female). Average age (SD) 46.6 ± 17.2 yr	EAT, PAC-SYM, HADS, VSI, ARM, colonic transit testing (24 radiopaque markers)	19% had clinically significant ED pathology. ED pathology might contribute to constipation via gastrointestinal-specific anxiety
Dykes et al[52], 2001	Past and current psychological factors associated with slow and normal transit constipation.	28 consecutive constipated female patients, mean age 38.2 yr (SD 10.8 yr)	SCID, SF-36, EAT	1/5 current affective disorder, 2/3 previous affective disorder, 1/3 distorted attitudes to food
Waldholtz et al[30], 1990	Type and frequency of GI symptoms. To follow symptoms during refeeding prospectively. Guidelines for gastrointestinal testing and intervention in hospitalized AN patients	16 consecutive AN patients chronically ill (4.5 ± 1.2 yr); 71.6% ± 2.9% of matched population weight, 12 HC	AN patients rated on 12 gastrointestinal symptoms before and after nutritional rehabilitation GISS (24 questions); blood tests physical examination	Belching did not improve during treatment; no patients required endoscopy, x-ray evaluation, or antipeptic regimens; although severe gastrointestinal symptoms are common in AN, they improve significantly with refeeding

AN: Anorexia nervosa; BN: Bulimia nervosa; EDNOS: Eating disorders not otherwise specified; HC: Healthy controls; BMI: Body mass index; WCS: Wexner constipation score; OD score: Obstructed defecation score; FIOSI: Fecal incontinence severity index; FGIDs: Functional gastrointestinal disorders; ENS: Eysenck neuroticism scale; BDI: Beck Depression Inventory; STAI: The State-Trait Anxiety Inventory; BSI: Brief Symptom Inventory; EEE-C: Eating and Exercise Examination/computerized; EDI-2: Eating Disorder Inventory-2; EAT: Eating attitudes test; ED: Eating disorders; IBS: Irritable bowel syndrome; FH: Functional heartburn; FAB: Functional abdominal pain disorder; FC: Functional constipation; Fano: Functional anorectal pain disorder; PAC-SYM: Patient Assessment of Constipation Symptom Questionnaire; VSI: Visceral Sensitivity Index; ARM: High-Definition Anorectal Manometry; SCID: Structured Clinical Interview for DSM; SF-36: Short Form (36) Health Survey.