Background & Aims

Individuals with eating disorders (EDs) frequently have constipation-related symptoms, although the mechanisms of this relationship are not clear. We examined the frequency of and relation between EDs and constipation in patients with chronic constipation referred for anorectal manometry.

Methods

We analyzed data from 279 patients with chronic constipation (79.2% female) evaluated at a tertiary center from June 2017 through September 2018. Participants completed a standardized psychometric assessment (patient assessment of constipation symptoms questionnaire and hospital anxiety and depression scale and visceral sensitivity index analyses) and anorectal manometry. A subset of patients completed colonic transit testing. Participants with clinically significant ED pathology were identified based on scores of 20 or higher on the Eating Attitudes Test-26. We performed a logistic regression analysis to examine factors associated with the likelihood of having ED pathology. Odds ratios were calculated based on continuous variables. We examined the contribution of anxiety to the relationship between severity of ED pathology and symptoms of constipation (such as abdominal pain) using a regression-based bootstrapping approach.

Results

Of the study participants, 53 (19.0%) had clinically significant ED pathology. The presence of ED pathology was associated with greater general anxiety scores, based on the hospital anxiety and depression scale (odds ratio, 1.20; 95% CI, 1.05–1.38), and greater gastrointestinal-specific anxiety scores, based on the visceral sensitivity index (odds ratio, 1.06; 95% CI, 1.03–1.09). Gastrointestinal-specific anxiety fully mediated the relationship between the severity of ED pathology and constipation (standardized β, 0.11–0.16; P = .026–.024). We found no differences in anorectal manometry or colonic transit between patients with vs without ED pathology.

Conclusions

In an analysis of patients with chronic constipation, we found that 19% had clinically significant ED pathology. Our preliminary finding indicated that ED pathology might contribute to constipation via gastrointestinal-specific anxiety. Clinicians should consider screening patients with chronic constipation for EDs—especially patients who report symptoms such as bloating and abdominal pain.

中文翻译：

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慢性便秘患者饮食失调病理的频率和胃肠特异性焦虑的贡献。

背景与目标

饮食失调 (ED) 患者经常出现便秘相关症状，尽管这种关系的机制尚不清楚。我们检查了慢性便秘患者进行肛门直肠测压的频率和 ED 与便秘之间的关系。

方法

我们分析了 2017 年 6 月至 2018 年 9 月在三级中心评估的 279 名慢性便秘患者（79.2% 女性）的数据。参与者完成了标准化的心理测量评估（便秘症状问卷和医院焦虑和抑郁量表的患者评估以及内脏敏感性指数分析） ) 和肛门直肠测压。一部分患者完成了结肠传输测试。根据饮食态度测试 26 的 20 分或更高分确定具有临床显着 ED 病理的参与者。我们进行了逻辑回归分析以检查与患有 ED 病理的可能性相关的因素。优势比是基于连续变量计算的。

结果

在研究参与者中，53 人 (19.0%) 有临床上显着的 ED 病理。根据医院焦虑和抑郁量表（比值比，1.20；95% CI，1.05-1.38），ED 病理的存在与更高的一般焦虑评分相关，以及基于内脏敏感性指数的更高的胃肠道特异性焦虑评分（优势比，1.06；95% CI，1.03–1.09）。胃肠道特异性焦虑完全调节了 ED 病理的严重程度与便秘之间的关系（标准化 β，0.11-0.16；P  = .026-.024）。我们发现有与没有 ED 病理的患者在肛门直肠测压或结肠传输方面没有差异。

结论

在对慢性便秘患者的分析中，我们发现 19% 的患者患有具有临床意义的 ED 病理。我们的初步发现表明，ED 病理可能通过胃肠道特异性焦虑导致便秘。临床医生应考虑对慢性便秘患者进行 ED 筛查——尤其是报告有腹胀和腹痛等症状的患者。