• Aiko Koga, Kenta Toda, Keita Tatsushima, Sunao Matsuubayashi, Naho Tamura, Masatoshi Imamura, and Keisuke Kawai.
• Department of Psychosomatic Medicine, Kohnodai Hospital, National Center for Global Health Medicine, Ichikawa City, Chiba, Japan.
• Int J Eat Disord. 2019 Feb 1; 52 (2): 211-215.

ObjectiveThere has been no report on portal hypertension related to anorexia nervosa (AN).MethodWe 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).ResultsCase 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.DiscussionWe 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.© 2019 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc.

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