Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

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Abstract

Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

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Clinical guideline: management of gastroparesis.

Michael Camilleri, Henry Parkman, Mehnaz Shafi … (2013)

This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control. Patient nutritional state should be managed by oral dietary modifications. If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered. Parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained. Medical treatment entails use of prokinetic and antiemetic therapies. Current approved treatment options, including metoclopramide and gastric electrical stimulation (GES, approved on a humanitarian device exemption), do not adequately address clinical need. Antiemetics have not been specifically tested in gastroparesis, but they may relieve nausea and vomiting. Other medications aimed at symptom relief include unapproved medications or off-label indications, and include domperidone, erythromycin (primarily over a short term), and centrally acting antidepressants used as symptom modulators. GES may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies. Second-line approaches include venting gastrostomy or feeding jejunostomy; intrapyloric botulinum toxin injection was not effective in randomized controlled trials. Most of these treatments are based on open-label treatment trials and small numbers. Partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients. Attention should be given to the development of new effective therapies for symptomatic control.

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Eating disorders.

Janet Treasure, Angélica M. Claudino, Nancy Zucker (2010)

This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery. Copyright 2010 Elsevier Ltd. All rights reserved.

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Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence.

Janet Treasure, Daniel L. Stein, Sarah Maguire (2015)

To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Med

Journal ID (iso-abbrev): J Clin Med

Journal ID (publisher-id): jcm

Title: Journal of Clinical Medicine

Publisher: MDPI

ISSN (Electronic): 2077-0383

Publication date (Electronic): 25 February 2019

Publication date Collection: February 2019

Volume: 8

Issue: 2

Electronic Location Identifier: 278

Affiliations

[1 ]Maison de Solenn-Maison des Adolescents, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; corinne.blanchet@ 123456aphp.fr (C.B.); marie-emilie.carles@ 123456aphp.fr (M.-E.C.)

[2 ]CESP, INSERM 1178, Paris-Descartes University, USPC, 75014 Paris, France

[3 ]French Federation Anorexia Bulimia (FFAB), 75014 Paris, France; s-guillaume@ 123456chu-montpellier.fr (S.G.); flora.bat@ 123456ap-hm.fr (F.B.-P.); julia.clarke@ 123456aphp.fr (J.C.); dodin.vincent@ 123456ghicl.net (V.D.); phduriez@ 123456gmail.com (P.D.); priscille.gerardin@ 123456chu-rouen.fr (P.G.); mouna.hanachi@ 123456aphp.fr (M.H.-G.); sylvain.iceta@ 123456chu-lyon.fr (S.I.); berenice.segrestin@ 123456chu-lyon.fr (B.S.); chantal.stheneur@ 123456fsef.net (C.S.)

[4 ]Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, 34090 Montpellier, France

[5 ]INSERM U1061, University of Montpellier, 34090 Montpellier, France

[6 ]Child and Adolescent Psychopathology Unit, Salvator Hospital, Public Assistance-Marseille Hospitals, 13009 Marseille, France

[7 ]Institut de la Timone, CNRS, Aix-Marseille University, 13005 Marseille, France

[8 ]Child and Adolescent Psychiatry Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France

[9 ]INSERM U894, Institute of Psychiatry and Neuroscience of Paris (IPNP), 75013 Paris, France

[10 ]Clinique Médico-Psychologique, Neurosciences Hôpital Saint Vincent de Paul, 59000 Lille, France

[11 ]Faculté de Médecine et de Maïeutique de Lille, 59800 Lille, France

[12 ]Sainte-Anne Hospital (CMME), Paris Descartes University, 75014 Paris, France

[13 ]Pôle universitaire de psychiatrie de l’enfant et de l’adolescent CH du Rouvray-CHU de Rouen, 76300 Rouen, France

[14 ]CRFDP, UFR des Sciences de l’Homme et de la Société, Rouen University, 76130 Mont-Saint-Aignan, France

[15 ]Clinical Nutrition Unit, Raymond Poincaré University Hospital, Assistance Publique-Hôpitaux de Paris, 92380 Garches, France

[16 ]CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, 94800 Villejuif, France

[17 ]Referral Center for Eating Disorder, Hospices Civils de Lyon, 69677 Bron, France

[18 ]Equipe PSYR2, INSERM U1028, CNRS UMR5292, Université Lyon 1, 69002 Lyon, France

[19 ]Pediatric Endocrinology Diabetology Department, Reference Centre for Endocrine Growth and Development Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; juliane.leger@ 123456aphp.fr

[20 ]Paris Diderot University, Sorbonne Paris Cité, F-75019 Paris, France

[21 ]Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, DHU Protect, F-75019 Paris, France

[22 ]INSERM 1060, Laboratoire CARMEN, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Claude Bernard University, Lyon 1, Pierre Bénite, 69310 Lyon, France

[23 ]Centre Médical et Pédagogique, Fondation Santé des Etudiants de France, 91480 Varennes Jarcy, France

[24 ]Faculté de Médecine, Université de Montréal, Quebec, QC H3C 3J7, Canada

[25 ]Adolescent and Young Adult mental health department, Fondation Santé des Etudiants de France, 75014 Paris, France

[26 ]UFR Simone Veil-Santé, 78690 Saint-Quentin en Yvelines, France

Author notes

[* ]Correspondence: nathalie.godart@ 123456fsef.net ; Tel.: +33-6-2186-6601

Author information

Philibert Duriez https://orcid.org/0000-0001-7321-6820

Mouna Hanachi-Guidoum https://orcid.org/0000-0002-7228-8723

Sylvain Iceta https://orcid.org/0000-0002-0054-1865

Article

Publisher ID: jcm-08-00278

DOI: 10.3390/jcm8020278

PMC ID: 6406645

PubMed ID: 30823566

SO-VID: fcc4aae5-abf4-4674-b90a-097ad2ac5034

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

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Wits Journal of Clinical Medicine

Most cited references 170

Clinical guideline: management of gastroparesis.

Eating disorders.

Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence.

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