Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.
Acute Disease ; Adolescent ; Anorexia Nervosa/complications/*diagnosis ; Emphysema/complications/*diagnosis ; Female ; Gastric Dilatation/complications/*diagnosis/radiography ; Humans ; Intubation, Gastrointestinal ; Superior Mesenteric Artery Syndrome/diagnosis ; Tomography, X-Ray Computed

Anorexia nervosa, a syndrome most commonly affecting young women, is characterized by weight less than 85% of weight that is considered normal for that person's age and height, distorted body image, and fear of becoming obese, and its mortality is up to 9%. We present a case of a 33-year-old woman with a 9-year history of anorexia nervosa. She admitted to our institution with decreased mentality, and her body mass index was 11.5 kg/m2 of the time admission. Initial aminotransferase level was severely elevated, but it was normalized solely with improved nutrition and weight gain. Five and sixteen days after the admission urinary tract infection and elevation of pancreatic enzymes occurred. They were successfully treated with antibiotics and nutritional support. Fifty seven days after the admission, she discharged. We report a case of acute hepatitis and pancreatitis treated with nutritional rehabilitation in a patient with severe anorexia nervosa for the first time in Korea.
Acute Disease ; Adult ; Alanine Transaminase/analysis ; Anorexia Nervosa/complications/*diagnosis ; Aspartate Aminotransferases/analysis ; Body Mass Index ; Female ; Humans ; Lipase/analysis ; Liver Diseases/enzymology/*etiology/therapy ; Nutrition Therapy ; Pancreatic Diseases/enzymology/*etiology/therapy ; Weight Gain

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.
Adolescent ; Anorexia Nervosa/*complications ; Antidepressive Agents/therapeutic use ; Cognitive Therapy ; Endoscopy, Gastrointestinal ; Female ; Fluoxetine/therapeutic use ; Humans ; Parenteral Nutrition, Total ; Superior Mesenteric Artery Syndrome/*diagnosis/*etiology/therapy ; Tomography, X-Ray Computed

INTRODUCTIONThe prevalence rate of anorexia nervosa is lower in Asia than in the West, although studies have found that it is on the rise in Asia. This study aims to present the clinical profile of patients presenting with anorexia nervosa in Singapore.

METHODSThe present study used archival data from the Eating Disorder Programme registry of the Department of Psychiatry, Singapore General Hospital, Singapore. Patient records from 2003 to 2010 were collected and analysed. Presenting characteristics of the patients were also compared with those of another local study conducted eight years earlier.

RESULTSFrom 2003 to 2010, a total of 271 patients were diagnosed with anorexia nervosa by a psychiatrist in our hospital. Of these, 251 (92.6%) were female and 238 (87.8%) were Chinese. Our patients had a lower mean weight (36.83 kg, p < 0.001) and a lower mean body mass index (BMI) (14.43 kg/m(2), p < 0.001) than patients from the previous local study. Almost half of all our patients (n = 135, 49.8%) were diagnosed with at least one psychiatric comorbidity and 50 (18.5%) had a history of self-harm.

CONCLUSIONThe presenting characteristics of our study cohort were similar to those of the Western population. However, the lower presenting weight and BMI in our cohort indicates that cases seen today are more severe than those seen eight years ago. Therefore, it is important to put in place prevention programmes to help adolescents cultivate a healthy body image as well as early intervention programmes to improve detection rates and treatment outcomes.

Adolescent ; Adult ; Anorexia Nervosa ; diagnosis ; epidemiology ; ethnology ; therapy ; Asian Continental Ancestry Group ; Body Image ; Body Mass Index ; Body Weight ; Child ; Comorbidity ; Female ; Follow-Up Studies ; Humans ; Male ; Prevalence ; Retrospective Studies ; Self-Injurious Behavior ; complications ; Singapore ; Treatment Outcome ; Young Adult

INTRODUCTIONAnorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders.

METHODSA retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI.

RESULTSPatients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05).

CONCLUSIONSeverity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.

Adolescent ; Adult ; Alanine Transaminase ; blood ; Alkaline Phosphatase ; blood ; Anorexia Nervosa ; complications ; diagnosis ; epidemiology ; Aspartate Aminotransferases ; blood ; Body Mass Index ; Child ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Feeding and Eating Disorders ; complications ; diagnosis ; epidemiology ; Female ; Humans ; Liver Diseases ; complications ; diagnosis ; epidemiology ; Liver Function Tests ; Male ; Mental Disorders ; complications ; diagnosis ; epidemiology ; Odds Ratio ; Prevalence ; Psychiatric Status Rating Scales ; Retrospective Studies ; Singapore