Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients

OBJECTIVE: There has been no report on portal hypertension related to anorexia nervosa (AN). METHOD: We describe three cases of portal hypertension manifesting with collateral circulation represented by gastroesophageal varices in prolonged AN with laxative abuse and self‐vomiting. These women, in their 20s to 50s, were diagnosed as having AN binging and purging type (AN‐BP) that included self‐induced vomiting and abuse of irritating laxatives (more than 100 tablets daily). RESULTS: Case 1 showed prominent ascites and a gastro‐renal shunt on computed tomography scanning. Case 2 showed gastroesophageal varices on endoscopic examination. Case 3 showed gastroesophageal varices on computed tomography scanning and endoscopic examination. We performed liver biopsies in all patients and found only slight pericellular fibrosis. Our patients showed typical symptoms of portal hypertension, although liver cirrhosis was not present. DISCUSSION: We speculated that abnormal eating and purging behaviors were involved in the development of portal hypertension. We hypothesized that long‐term laxative abuse, dehydration, and abnormal eating behavior are involved in the development of portal hypertension, considering these were common features in our patients. Portal hypertension and gastroesophageal varices should be considered as one of the potentially existing complications in prolonged AN‐BP with self‐induced vomiting and abuse of irritating laxatives.