Digestive and Liver Disease 45 (2013) 639–644 Contents lists available at SciVerse ScienceDirect Digestive and Liver Disease j ourna l ho mepage: www.elsevier.com/lo cate/dld Alimentary tract Audit of digestive complaints and psychopathological traits in patients with eating disorders: A prospective study Beatrice Salvioli a,∗ , Alessandro Pellicciari b , Luisa Iero b , Elena Di Pietro a , Filomena Moscano b , Stefano Gualandi c , Vincenzo Stanghellini d , Roberto De Giorgio d , Eugenio Ruggeri d , Emilio Franzoni b a Humanitas Clinical and Research Center, Rozzano (Mi), Italy b Child Neuropsychiatry Unit, Sant’Orsola Malpighi Hospital, University of Bologna, Italy c Clinical Pediatrics, Sant’Orsola Malpighi Hospital, University of Bologna, Italy d Department of Clinical Medicine, University of Bologna, Bologna, Italy a r t i c l e i n f o Article history: Received 25 September 2012 Accepted 27 February 2013 Available online 9 April 2013 Keywords: Eating disorders Esophago-gastrointestinal symptoms MMPI Psychopathological traits a b s t r a c t Background: Esophago-gastrointestinal symptoms are frequently reported by patients with eating disor- ders. Scanty data exist on the relationship between psychopathological traits and digestive complaints. Aims: To prospectively analyze (i) prevalence of digestive symptoms; (ii) psychopathological traits; (iii) relationship between symptom scores and psychopathological profiles. Methods: Psychopathological and digestive symptom questionnaires were completed at baseline, at dis- charge, at 1 and 6 months’ follow-up in 48 consecutive patients (85.4% female, median age, 15 years) hospitalized for eating disorders. Results: The most frequently reported symptoms were postprandial fullness (96%) and abdominal disten- tion (90%). Pooled esophageal (4; IQR 0–14) and gastrointestinal (34; IQR 19–53) symptoms significantly decreased at 6 months’ follow-up (1; IQR 0–3 and 10; IQR 4–34; p < 0.0001 and p < 0.005, respectively). Pooled gastrointestinal symptoms significantly correlated with hypochondriasis (r = 0.42, p < 0.01). Both esophageal and gastrointestinal symptoms improved in patients with normal values of hypochondriasis and hysteria scales (p < 0.05 and p < 0.005, respectively) compared to those with pathological traits. Conclusions: Digestive symptoms are frequently reported by patients with eating disorders with their expression and outcome being influenced by psychopathological profiles. Hypochondriasis and hysteria traits are predictive factors for symptomatic improvement. © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. 1. Introduction Eating disorders (ED), i.e. anorexia nervosa, bulimia nervosa and unspecified eating disorders, are characterized by aberrant pat- terns of eating behavior and weight regulation and, specifically in anorexia nervosa, there is likewise a disturbed perception of body weight and shape [1,2]. Besides physical and laboratory abnor- malities, patients with ED often present functional and/or organic gastrointestinal (GI) disorders [3,4], which might be directly or indirectly related to underlying psychopathological abnormalities [5,6]. Digestive symptoms are more commonly observed in patients with anorexia nervosa who display a lack of insight that may lead them to report digestive complaints commonly interpreted by doc- tors as expression of “somatization” [7,8]. Patients with either ∗ Corresponding author at: Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Mi), Italy. Tel.: +39 0282244569; fax: +39 0282244590. E-mail address: beatrice.salvioli@humanitas.it (B. Salvioli). anorexia nervosa or bulimia nervosa often report a wide array of GI complaints [9,10] including symptoms suggestive of early satiety, postprandial discomfort [11], constipation, abdominal full- ness, acute intestinal occlusion and swollen salivary glands [12,13]. Digestive symptoms may delay the diagnosis of ED as these patients are often referred to gastroenterologists for their complaints and receive medication for the GI tract rather than psychiatric treat- ments [8,14]. Moreover, psychiatric co-morbidities, including Axis I diagnoses (affective and anxiety disorders) [15] and Axis II person- ality disturbances (obsessive-compulsive, avoidant and schizoid personalities) [16], can contribute to worsen GI symptoms and often complicate case conceptualization and treatment planning [17]. Studies revealed that in ED patients Minnesota Multipha- sic Personality Inventory (MMPI) scales are abnormally high [18] and specific psychological traits, such as somatization, neuroticism and anxiety, predict a high prevalence of functional GI disorders [19]. Recent data report a turnover of functional gastrointestinal disorders after 12 months in patients with ED, with no apparent relationship with eating behaviors, psychological variables or body weight change [20]. However, whether the presence and evolution 1590-8658/$36.00 © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2013.02.022