吐血を繰り返す神経性食欲不振症の1例
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概要
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This report concerns a 26-year-old woman with anorexia nervosa complicated by anemia due to repeated hematemesis. She began to suffer from vomiting after meals and anorexia 4 years ago .and since then she had been repeating binge eating and vomiting. Her weight had decreased from 47 kg to 38 kg and she beame amenorrhea. Two years ago her weight decreased to 30 kg, and from that time on, she began noticing blood mixed in her vomited material. She with as admitted to the hospital on an emergency basis for hematemesis. During hospitalization, the patient's hematemesis and vomiting were alleviated, but whenever she was discharged from the hospital, the hematemesis recurred, so she became anemic, and a blood transfusion was carried out over again. Upper gastrointestinal endoscopy was conducted repeatedly, the finding of .hemorrhagic gastritis was observed, but local hemorrhagic source like as a gastric ulcer or laceration was unclear. In the cases of eating disorders, it is predicted that irritation due to chronic malnutrition, binge eating, and vomiting affects the gastrointestinal tract. Accordingly, it is thought that patients with eating disorders should be placed at great risk for digestive tract disorders. However, there have been few reports to date of gastrointestinal bleeding related to vomiting in patients with eating disorders. As one of the reasons for the rareness of the reports, it can be hypothesized that habitual vomiting as a background factor for hematemesis is difficult to be detected because of their denial, .so that the patients are not diagnosed as eating disorders and treated only as cases of digestive tract disorders. On the other hand, some investigators claimed that these peculiar behaviors only rarely result in gastrointestinal disease. Concerning frequency of incidence of gastrointestinal complications, Hall and Cuellar et al. reported that the frequency of those is relatively high, but Kiss et al. report that digestive tract mucosal injury due to long-term vomiting and binge eating is limited and not so frequent. Up to date, a uniform conclusion cannot be reached. Conclusively, according to our case of anorexia nervosa with repeated hematemesis, we recognized the needs that we should notice the existence of "masked" eating disorders in patients with digestive tract bleeding for understanding the mechanism and frequency of gastrointestinal tract complication of eating disorders.
- 日本心身医学会の論文
- 1992-06-01
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