How bulimia affects the upper GI and respiratory tract

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Bulimia nervosa (BN) is an eating disorder that involves frequent purging, by self induced vomiting, as a means to lose weight that can have life-threatening effects on the body. Over time, this damages the upper gastrointestinal tract (upper GI), including the mouth, throat, and esophagus. Purging can also damage the respiratory system, including the voice box (larynx) and lungs. Though very serious, these complications are treatable with prompt medical attention.

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Common upper GI and respiratory tract complications from bulimia

Common complications in the upper GI tract vomiting can include: (1,2,3) 

  • Loss of gag reflex
  • Oral, dental, and gum disease, decay, and ulceration
  • Acid reflux–If this becomes severe and chronic, it can mature into gastroesophageal reflux disease (GERD) that can only be treated with strict diet changes and daily acid-lowering medications.-
  • Esophageal dysmotility–chronic vomiting damages muscles in the esophagus that push food from the mouth into the stomach, which cause food to become stuck in the esophagus and require surgical removal
  • Abdominal pain, spasms, and bloating
  • Blood stained vomit (hematemesis) from micro tears in the esophagus
  • Boerhaave syndrome (pneumomediastinum)--a life threatening condition when chronic vomiting causes the esophagus to rupture and stomach bacteria, gas, and acid to enter the chest cavity, which requires immediate ER and surgical intervention
  • Mallory-Weiss syndrome–when. tears in the esophagus from chronic vomiting become large enough to result in the person vomiting a life threatening amount of blood (This differs from Boerhaave syndrome in that the entire esophagus does not rupture.)

Esophageal cancer

Stomach acid has an acidic pH that ranges from 1.5 - 3.5. Repeated vomiting burns away the lower esophageal sphincter (LES), the esophagus, and tissue inside the mouth. The LES is a valve that separates the stomach and esophagus. When this erodes, it results in painful, permanent acid reflux that can only be corrected with surgery. 

This adds to the problems listed above but can also lead to permanent changes in the cells that line the lower esophageal sphincter, called Barrett’s esophagus. If left untreated, this can develop into esophageal cancer. (4)

Damage to lungs

If someone accidentally chokes while vomiting, the vomit can aspirate into the lungs. Stomach fluid contains a lot of normal flora (bacteria) that aid in digesting food. While this flora is safe within the stomach, if it enters the respiratory tract, such as the lungs, it causes life threatening infections. Stomach fluid contains numerous digestive enzymes including: pepsin, hydrochloric acid, and gastrin, to name a few. These enzymes digest the lining of the respiratory tract as easily as they do food. (5)

Gastric acid causes severe chemical burns within the respiratory tract, sometimes called a flash burn. Not only does this cause pain, but the immune system releases inflammatory cells called neutrophils to fight the impending infection and repair the burned tissue. The inflammatory response causes fluid to accumulate in the lungs, making breathing difficult. (5)

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Acute respiratory distress syndrome

The respiratory tract is a small tube that does not contain excess room for tissue swelling. If the burn is severe enough, the tissue can swell to the point of complete obstruction and suffocation.

The obstruction, burn, and impending infection can result in acute respiratory distress syndrome (ARDS) that requires immediate intubation and ICU care. (5) 

Intubation is the procedure that entails inserting a breathing tube down into the trachea. This tube is then connected to a ventilating machine that pumps oxygen in and out of the lungs. The endotracheal tube can be removed after a few days, once the swelling inside the respiratory tract has begun to heal, and the physician is confident the patient can breathe on his or her own. Inside the hospital, a critical care pulmonologist may perform a bronchoalveolar lavage (BAL) to suction the excess particulate matter that was aspirated. (5) 

Choking and aspiration from chronic vomiting are a common but very serious complication in those who suffer from severe bulimia nervosa. These and other complications to the upper gastrointestinal tract and respiratory system can be treated, but they require immediate medical attention.

Complications like these are often what finally prompt individuals with eating disorders to get help. But the sooner someone seeks treatment, the better the chances are for a full recovery. Call our team at Within Health today to learn about our attuned, virtual care programs for eating disorders like bulimia.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Mitchell, J., Christie, Z. (2021). Bulimia nervosa and binge eating disorder in adults. UpToDate
  2. Mehler, P.S., Birmingham, L.C., Crow, S.J., Jahraus, J.P. Medical complications of eating disorders. The Treatment of Eating Disorders: A Clinical Handbook. Grilo, C.M., Mitchell, J.E. (Eds), The Guilford Press, New York (2010). P.66.
  3. Eating Disorders: Core Interventions in the Treatment of and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. (2020). National Institute for Clinical Excellence, Clinical Guideline 9. http://guidance.nice.org.uk.
  4. Barrett’s esophagus. Mayoclinic.com. Last updated 19 May, 2020. Accessed 26 Jan, 2022. https://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841
  5. Klompas, M. Aspiration pneumonia in adults. UpToDate.

FAQs

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