Case Study
Esophageal cancer in a young woman with bulimia nervosa: a case report
Eric T Shinohara, Samuel Swisher-McClure, Michael Husson, Weijing Sun and James M Metz
Journal of Medical Case Reports 2007, 1:160 doi:10.1186/1752-1947-1-160
Received: 27 July 2007
Accepted: 29 November 2007
Published: 29 November 2007
Introduction
In the past twenty-five years, the prevalence of esophageal adenocarcinoma has increased dramatically within the United States and it is now the most common histological type of esophageal cancer [1]. Despite advances in treatment, adenocarcinoma of the esophagus has a poor prognosis [2]. A recent study of patients with resectable disease demonstrated 5 year overall survivals of 81%, 51%, 14%, and 0% for stage I through IV respectively . Previously implicated risk factors for esophageal adenocarcinoma include gastroesophageal reflux disease, tobacco use, obesity, and Barrett's esophagus. Prior reports have also suggested that chronic bulimia nervosa (BN) is a risk factor for the development of esophageal adenocarcinoma. Repeated microtrauma, due to vomiting, may contribute to the malignant transformation of the esophageal tissue. We report the case of a 27 year old female patient with a remote history of BN recently diagnosed with adenocarcinoma of the esophagus.
Case presentation
A 27 year old female presented with a one year history of progressively worsening epigastric pain, reflux, and fatigue. She was initially treated with acid suppression therapy by her primary care physician, which temporarily relieved her symptoms. However, her symptoms became refractory to medication and she noted the onset of dysphagia. She reported a remote history of bulimia nervosa (BN) of approximately one year duration at the age of 17. She reported episodes of binge eating and self-induced vomiting, at least once a day. She denied any further history of bulimia since that time, which was corroborated by her mother. The patient reported smoking approximately
Eric T Shinohara, Samuel Swisher-McClure, Michael Husson, Weijing Sun and James M Metz
Journal of Medical Case Reports 2007, 1:160 doi:10.1186/1752-1947-1-160
Received: 27 July 2007
Accepted: 29 November 2007
Published: 29 November 2007
Introduction
In the past twenty-five years, the prevalence of esophageal adenocarcinoma has increased dramatically within the United States and it is now the most common histological type of esophageal cancer [1]. Despite advances in treatment, adenocarcinoma of the esophagus has a poor prognosis [2]. A recent study of patients with resectable disease demonstrated 5 year overall survivals of 81%, 51%, 14%, and 0% for stage I through IV respectively . Previously implicated risk factors for esophageal adenocarcinoma include gastroesophageal reflux disease, tobacco use, obesity, and Barrett's esophagus. Prior reports have also suggested that chronic bulimia nervosa (BN) is a risk factor for the development of esophageal adenocarcinoma. Repeated microtrauma, due to vomiting, may contribute to the malignant transformation of the esophageal tissue. We report the case of a 27 year old female patient with a remote history of BN recently diagnosed with adenocarcinoma of the esophagus.
Case presentation
A 27 year old female presented with a one year history of progressively worsening epigastric pain, reflux, and fatigue. She was initially treated with acid suppression therapy by her primary care physician, which temporarily relieved her symptoms. However, her symptoms became refractory to medication and she noted the onset of dysphagia. She reported a remote history of bulimia nervosa (BN) of approximately one year duration at the age of 17. She reported episodes of binge eating and self-induced vomiting, at least once a day. She denied any further history of bulimia since that time, which was corroborated by her mother. The patient reported smoking approximately