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Heartburn Drug May Ease Eating Disorder Complication

Proton-pump inhibitor helps restore metabolism balance

THURSDAY, Jan. 10, 2002 (HealthDayNews) -- A family of potent heartburn drugs may help prevent deadly metabolic complications in patients with severe anorexia or bulimia, Japanese researchers say.

Some people with eating disorders suffer grave imbalances of electrolytes -- vital molecules that include sodium and potassium -- because their vomiting and starvation force them to live off their own muscle. However, researchers in Fukushima, Japan, say they corrected this complication in a female patient by giving her the drug lansoprazole, which belongs to a family of compounds called proton-pump inhibitors, which reduce stomach acid.

Dr. Harry A. Brandt, director of the Centers for Eating Disorders, says the drugs could help patients with electrolyte disturbances. However, he says, while correcting those complications is important, treating the underlying mental disorder is crucial.

"I think the primary goal in the treatment of anorexia would be to correct the behavioral disturbance or [patients] are going to be able to override" the other therapy by continuing to vomit and starve themselves, Brandt says.

An estimated 1 percent of American girls suffer from anorexia nervosa, and 2 percent to 3 percent have bulimia, according to the U.S. Department of Health and Human Services' Office on Women's Health. Both conditions also occur in men, although less frequently.

Brandt says a "very high percentage" of patients develop an electrolyte imbalance, which is the principal cause of death associated with eating disorders. Thanks to improved treatments for these disruptions, the fatality rate among anorexics and bulimics has fallen from about 16 percent in the late 1980s to between 5 percent and 7 percent in recent years.

"You can only go so far, and if you don't keep everything in balance, boom, that's when we start losing patients," he says.

The latest report appears as a research letter in today's issue of the New England Journal of Medicine.

The woman, 32, had been hospitalized for profound weight loss after four years of self-induced vomiting, a main feature of bulimia, and a three-year history of anorexia. She was 5-foot-3-inches tall and weighed barely 72 pounds upon admission. The woman also had hypokalemia, or low blood levels of potassium, which can lead to fatal heart problems.

Because of the depressed potassium, the patient had unhealthy heart function. Her urine was also abnormally rich in negatively charged particles, or anions, because of the constant voiding of stomach acid with positively charged molecules that would normally neutralize the fluid.

The doctors first administered potassium supplements, but because the woman continued to vomit, they failed to correct the imbalance. They then started her on 15 milligrams a day of lansoprazole, which is sold as Prevacid by TAP Pharmaceutical Products.

Once on the proton-pump inhibitor, the patient's metabolic markers improved, although she continued to induce vomiting. During a year of monitoring, her body's potassium levels were stable and normal, the researchers say.

"Although treatment of the underlying psychiatric disorder is critical, therapy with a proton-pump inhibitor may be useful to ameliorate [metabolic disturbances] in some patients with anorexia nervosa or bulimia nervosa," the authors write.

Dr. David Garth, an emergency room physician at Mary Washington Hospital in Fredericksburg, Va., who has studied the treatment of hypokalemia, says he isn't aware of doctors in the United States using proton-pump drugs to level metabolic disorders. "But that's not to say it hasn't been done," he adds.

One drawback with the compounds, Garth says, is they're far more expensive than potassium chloride, the typical treatment for the condition. On the other hand, he notes, the proton-pump inhibitor may be easier on the stomach than the other drug, which can trigger nausea and stomach aches.

What To Do

For more on eating disorders, visit the Center for Eating Disorders or the National Eating Disorders Organization.

You can also try the Office on Women's Health.

SOURCES: Interviews with Harry A. Brandt, M.D., director, Center for Eating Disorders, and psychiatrist, St. Joseph Medical Center, Towson, Md.; David Garth, M.D., emergency room physician, Mary Washington Hospital, Fredericksburg, Va.; Jan. 10, 2002, New England Journal of Medicine
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