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Can acid in bulimia cause neoplasia?

Q - Does exposure of the oesophagus, throat and oral cavity to gastric acid increase the risk of neoplastic change with bulimia ?

A - Patients with bulimia nervosa expose their oesophagus, pharynx and oral cavity to gastric acid on a regular basis. You might therefore reasonably expect them to have signs of acid damage to these areas.

Several studies of the mouth and teeth in bulimic patients do indeed describe dental erosions and caries, mild oral mucosal inflammation and, more rarely, salivary gland hypertrophy. But no serious pre-cancerous diseases like leukoplakia or frank oral cancer have been reported.

Similarly, a number of endoscopic studies have shown 30-50 per cent of bulimic patients will have oesophagitis, erosions or other signs of acid harm.

Again, these changes are generally mild and usually no serious pathologies ­ such as Barrett's oesophagitis and colon cancer or frank malignancy ­ are found. This may be because the acid exposure in bulimia is intermittent and oesophageal peristalsis will clear acid relatively quickly. This is different from patients with gastro-oesophageal reflux disease in which acid exposure is more frequent or continuous and poor oesophageal clearance leads to acid staying in contact with the mucosa for longer.

There are anecdotal case reports of oesophageal cancer in bulimia in which nutritional deficiencies of zinc and vitamins A and E may be factors. But overall the literature indicates the risk of neoplastic change at any of these sites in bulimic patients is unlikely to be significantly higher than average.

Dr Meron Jacyna is a consultant gastroenterologist at Northwick Park and St Marks NHS Trust,

Harrow, Middlesex

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