Gastrointestinal alterations in anorexia nervosa - A systematic review

Eur Eat Disord Rev. 2019 Sep;27(5):447-461. doi: 10.1002/erv.2679. Epub 2019 May 7.


Objective: Anorexia nervosa (AN) is an eating disorder characterized by body schema disruptions, underweight (>15% reduction of the ideal body weight or a body mass index <17.5 kg/m2 ), self-induced weight reduction, and endocrine impairments. The three latter features greatly impact on most physiological functions including the cardiovascular, skeletal, reproductive, and the gastrointestinal system, which results in an increased mortality rate in affected individuals. Especially, gastrointestinal alterations are described as particularly bothersome by patients.

Methods: To address the need for a better understanding of the interplay between AN and the gastrointestinal (GI) tract, a systematic data search in the databases Medline, Embase, and PsycINFO was conducted.

Results: Over 1,235 studies were identified, out of these, 107 appropriate articles were selected and discussed in the present review.

Conclusion: AN has large impact on GI alterations and symptoms; conversely, GI symptoms may also affect the manifestation and course of AN as discussed in the present review. Despite increasing data, several gaps in knowledge exist especially on the pathophysiology underlying the changes described.

Keywords: complaint; eating disorder; gut-brain axis; microbiota; motility; psychosomatic.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anorexia Nervosa / physiopathology*
  • Gastrointestinal Tract / physiopathology*
  • Humans