Text Link

Learn more about the results we get at Within

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.

Learn more about the results we get at Within

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.

How bulimia affects the upper GI and respiratory tract

No items found.
No items found.

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.

 minutes read
Last updated on 
October 28, 2022
In this article

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)

You might be interested in

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  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.


Further reading

Dangers of bulimia nervosa on your health and well-being

Bulimia nervosa is an eating disorder characterized by extremes. People struggling with this condition move...

Recognizing bulimia nervosa symptoms in teenagers

Bulimia nervosa (BN) is a dangerous eating disorder that affects people of all ages, but the condition can...

How to be a supportive partner when dating someone with bulimia nervosa

A strong support system is one of the most important tools a person can have when recovering from an eating...

Can your heart recover from bulimia?

Bulimia nervosa (BN) is an eating disorder characterized by a cycle of restricting food, binging, and...

Treating bulimia and anemia

Bulimia and anemia tend to coexist. Bulimia nervosa (BN) is a type of eating disorder involving restricting...

Can bulimia cause high cholesterol?

Bulimia nervosa (BN) causes many short-term physical effects. However, long-ranging health concerns are...

Bulimia facts and statistics

Bulimia nervosa (BN) is an eating disorder characterized by a recurrent cycle of binging and purging...

Bulimia’s impact on your sleep

Bulimia nervosa (BN) can have a significant impact on numerous aspects of...

Does bulimia cause hearing loss?

Most people are familiar with the digestive system complications bulimia...

Why does bulimia cause broken blood vessels?

Attempts at vomiting put extra pressure on the blood vessels of the...

What is bulimia bloat?

Bulimia bloat is not a medical term, but it is frequently used to describe the distended (swollen) belly...

Which digestive problems does bulimia cause?

Bulimia nervosa (BN) is a serious mental health disorder, but the condition often manifests as a number of...

Why does bulimia shaking occur?

Bulimia nervosa (BN) is a serious mental health condition, but it manifests in a number of physical ways...

Can bulimia cause ulcers in the stomach?

The connection between bulimia and stomach ulcers is due to stomach...

Bulimia nervosa and thyroid issues

Bulimia nervosa (BN) is an eating disorder characterized by cycles of binging and purging, or periods of...

What is sialadentis, or bulimia cheeks?

Bulimia nervosa (BN) is one of the most widely-recognized eating disorders impacting...

How bulimia can (permanently) affect your teeth

Bulimia nervosa (BN) is a serious psychiatric disorder that involves frequent...

What are the complications of bulimia?

Bulimia nervosa (BN) is a serious eating disorder that can have a large impact on both mental and physical...

What are bulimia teeth?

When someone purges, which happens frequently when someone has bulimia nervosa...

The relationship between bulimia, skin, and acne

Bulimia nervosa (BN) is a mental health disorder, but the condition can also cause a number of physical...

Is there a relationship between bulimia, acid reflux, and GERD?

Acid reflux and gastroesophageal reflux disease (GERD) are medical conditions involving the movement of...

Is hair loss a symptom of bulimia nervosa?

Bulimia nervosa (BN) is an eating disorder that can lead to many medical comp...

How bulimia affects the jaw: pain and swelling problems

Bulimia nervosa (BN) is an eating disorder that affects many parts of the body, incl...

How bulimia affects your period

Eating disorders like anorexia nervosa (AN), binge eating disorder (BED), and bulimia nervosa (BN) may...

How bulimia affects the upper GI and respiratory tract

Bulimia nervosa (BN) is an eating disorder that involves frequent purging...

How bulimia affects your knuckles

Bulimia nervosa (BN) is a serious eating disorder, in which people engage in eating...

Blood in vomit from bulimia: esophagus damage caused by throwing up

Bulimia nervosa (BN) is a serious eating disorder that can have numerous medical complications if left...

Can bulimia cause cancer?

Some diseases are more likely to lead to cancer than others. For example, alcoholism...

Russell's sign: bulimia knuckles, hands and fingers

Although bulimia nervosa (BN) is an insidious disease, usually characterized by secretive behavior to mask...

Can bulimia cause headaches?

It’s common for individuals with bulimia nervosa (BN) to experience headaches. One...

Bulimia and pregnancy complications and birth defects

Pregnancy can be an exciting time for a mother-to-be. Many expectant mothers look...

Further reading

No items found.