QUESTIONS AND ANSWERS: BN and Esophageal Cancer?

Q: I am treating someone with bulimia nervosa who has developed squamous cell carcinoma of the esophagus. Is this common among people with EDs? (J.C., Dunhill, NC)

A: Although squamous cell carcinoma is the most common form of esophageal carcinoma worldwide, and is tied to advancing age, smoking, and alcohol abuse, finding it in someone with BN is rare. As a recent report concludes, acidic damage to esophageal mucosa caused by self-induced vomiting practiced as a method of weight control may be traced back to untreated BN.

Indian researchers led by Dr. Shivam Khanna  recently reported a case of carcinoma of the esophagus that had some interesting and thought-provoking ties to BN (Cureus. 2021. doi: 10.7759/cureus 15636).  The authors reported the case of a 20-year-old woman who presented complaining of dysphagia, or trouble swallowing, for the past 2 months. This occurred more commonly after eating solid foods than after drinking liquids. She reported having binge-eating episodes over the past 6 years. These binges were followed by guilt and episodes of self-induced vomiting. These actions had all arisen because of her concern about her body shape and weight.

When she was examined, her BMI was 18.2 kg/m2. She had eroded dental enamel, but all her lab test results were all within normal limits. On the basis of the eroded enamel and reflux acid erosion, the physicians tentatively diagnosed long-standing BN leading to esophageal carcinoma.

Endoscopy revealed a growth in her esophagus, and a biopsy found squamous cell carcinoma. She was placed on 5-fluorouracil and cisplatin, along with cognitive behavioral therapy and short serotonin reuptake inhibitors, in an attempt to treat her BN. She was reported to be doing well on follow-up.

This case highlights the possibility of uncommon but serious medical problems arising from eating disorders symptoms, even in a young person like this.

— SC 

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