Rare But Real Consequences of Binge Eating

What Is Acute Massive Gastric Dilatation?

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Many people seem to regard binge eating as a relatively benign eating disorder symptom, especially in comparison to restriction or purging. Furthermore, bingeing consequences are typically viewed as both consistent with the consequences of obesity (e.g., Type II diabetes mellitus, high blood pressure, high cholesterol levels, etc.) and gradual. Not necessarily true! A rare consequence of bingeing (eating an unusually large amount of food in a discrete period of time) can be acute massive gastric dilatation, which if not quickly attended to, can result in death.

Those who binge and those who treat people who binge will likely benefit by knowing about this.

First, in non-medical language, let’s define key terms here. Gastric dilatation means distention of the stomach. Ischemia means lack of blood flow. Necrosis means death of. Finally, perforation means tear.

Case Examples of Acute Massive Gastric Dilatation

Though there is scant literature available, case examples are provided below that illustrate the unexpected severity of when a binge goes wrong and triggers an urgent need for medical attention due to acute massive gastric dilatation.

Person with history of anorexia nervosa:

  • A 26-year-old female presented with symptoms that included abdominal pain,  2-hours of inability to vomit, and nausea. At intake, she reported no significant abnormal eating preceding the onset of her pain.
  • Her weight was in the low-normal BMI range; she was described as thin. 
  • Medical intervention revealed that her gastric content included approximately 2-gallons of partially digested food.
  • This patient eventually disclosed a past history of anorexia nervosa, binge/purge subtype, which had occurred in her teens. She also eventually disclosed 4 years without bingeing and a then a 1-hour binge preceding this presentation.
  • At the time of medical evaluation, she was suffering from acute gastric dilatation with some necrosis, which can be fatal if not accurately and quickly diagnosed and treated.

Person of normal weight with history of bingeing, excessive exercise and restriction:

  • A 28-year-old female presented with sudden abdominal discomfort and pain. The cause of symptoms was not reported at the time of admission.
  • Her weight was in the normal to low-normal BMI range.
  • Medical evaluation revealed and required removal of large amounts of undigested food.
  • The patient eventually disclosed a history of an eating disorder since childhood that relied on compensatory behaviors of restriction and excessive exercise. At the time of hospital admission, she had been experiencing daily binges (with purging) triggered by work stress.
  • At the time of admission, she was suffering from a massive dilatation of her stomach.

Person of what would be considered normal weight with history of obesity and atypical anorexia nervosa:

  • A 16-year-old female presented with severe pain, bloat and tenderness in the abdominal area after consuming a large meal at noon. Before the above-cited meal, a significant binge had reportedly occurred a whole 24-hours prior.
  • Her weight was described as normal.
  • A medical intervention removed 5 liters of undigested food. 
  • An eating disorder evaluation revealed that the patient had experienced atypical anorexia around 14 years of age. Her report indicated historic periods of both restrictive as well as more regular eating habits. About one-and-a-half years prior to the dilatation, she had experienced significant weight loss from a starting point of obese. At the time of this evaluation, a pattern of bingeing—possibly binge eating disorder—was noted.
  • A medical intervention revealed a massive acute dilatation, no perforation, but the stretched and enlarged stomach “nearly filled the complete abdominal cavity.” This could have been fatal if not treated.

Person with no history of an eating disorder:

  • A 17-year-old male presented with pain and distension in the abdomen area and a period of retching without vomiting. He had reportedly fasted about 24-hours for religious purposes. Then, he had a binge-like dinner on the night before he required emergency medical treatment the following night.
  • He was described as a “healthy boy” other than the abdominal issues.
  • A medical intervention removed about 5 liters of free fluid and undigested food in the abdominal cavity.
  • The patient reportedly had no history of an eating disorder.
  • He was suffering from acute gastric dilatation with ischemia and necrosis of the stomach wall. This could have lead to death if the patient had not received a timely medical intervention.

Person with bulimia nervosa:

  • A 22-year-old female presented with complaints of abdominal pain, diarrhea, and vomiting that began after consuming a large amount of food. There were no reported medical or psychological-related ailments at the time of admission.
  • There was an appearance of normal health and development (other than the distended abdomen).
  • A medical intervention removed 11 liters of gastric content.
  • Less than two days later, this patient passed away. After death, the family disclosed that the patient had been receiving psychological treatment for “bulimic attacks” (bingeing and purging).
  • She was suffering from acute gastric dilatation after binge eating and died from related complications.

Research and Community

Limited literature indicates that more research is needed to clarify risks and causes of acute gastric dilatation. A higher chance of occurrence has been reported for those who have a current or history of having had an eating disorder versus those who don’t have that history. However, as case examples illustrate here (more can be found with an Internet search), acute massive gastric dilatation can also happen to a person with an atypical eating disorder or no eating disorder at all. Research has also revealed that contrary to prior perceptions, patients of any weight may be susceptible to acute gastric dilatation.

People with acute gastric dilatation can experience nausea and vomiting or an inability to vomit, bloat/distension in the abdomen area, and sudden onset of abdominal pain. People who binge are encouraged to be cautious of fasting and binge eating patterns accompanied by abdominal pain. If working with a medical or mental health professional, discussing and monitoring these experiences may prove helpful. Immediate medical attention and treatment can be critical if massive gastric dilatation is suspected; there can be high mortality for people who experience this condition, and remedies for acute massive gastric dilatation are often of a surgical nature. Complications can include necrosis, perforation, shock, and death.

There seems to be a pervasive attitude among both the public and professionals about bingeing and binge eating disorder appearing less acutely dangerous than anorexia nervosa or bulimia nervosa. However, there can be sudden and severe consequences from bingeing. It seems that anyone who binges, loves someone who binges, or treats someone who binges may help save a life by knowing about this rare but potentially deadly condition.

Fortunately, successful treatments for binge eating disorder and related problems are available.

Sources:

Dewangan M, Khare MK, Mishra S, Marhual JC. Binge eating leading to acute gastric dilatation, inchemic necrosis and rupture—a case report. J Clin Diagn Res. 2016;10(3).

Gyurkovics E, Tihanyi B, Szijarto A, Kaliszky P, Temesi V, Hedvig SA, Kupcsulik P. Fatal outcome from extreme acute gastric dilation after an eating binge. Int J Eat Disord. 2006;39(7):602-5.

Holtkamp K, Mogharrebi R, Hanisch C, Schumpelick V, Herpertz-Dahlmann B. Gastric dilatation in a girl with former obesity and atypical anorexia nervosa. Int J Eat Disord. 2002;32(3):372-6.

Lemke J, Scheele J, Schmidt S, Wittau M, Henne-Bruns D. Massive gastric dilatation caused by eating binges demanding surgical intervention: a case report. GMS Interdiscip Plast Reconstr Surg DGPW, 2014;3.

Tweed-Kent AM, Fagenholz PJ, Alam HB. Acute gastric dilatation in a patient with anorexia nervosa binge/purge subtype. J Emerg Trauma Shock. 2010;2(4):403-405.

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