Proton pump inhibitors, or PPIs, are medications that reduce the amount of acid produced by the stomach. They are commonly used to treat gastrointestinal and esophageal issues caused by excessive stomach acid. Some PPIs are available over-the-counter, while others require a prescription. Although side effects are generally mild and PPIs are considered safe, dangerous allergic reactions may rarely occur, and long-term use is associated with greater risk of magnesium deficiency, vitamin B12 deficiency, kidney disease, bone fractures, and Clostridioides difficile infection.

Proton Pump Inhibitors (PPIs)

Boerhaave's syndrome refers to a dangerous condition in which the esophageal wall completely ruptures due to straining, typically as a result of severe vomiting. Men over the age of 50 who drink heavily are at the greatest risk, but patients with binge eating disorder and/or bulimia nervosa are also at increased risk, in addition to those with pre-existing esophageal conditions. Symptoms include severe radiating pain from the chest and esophagus, swelling of the chest cavity tissues, nausea, vomiting, hyperventilation, abdominal distension, fever, and sweating. If left untreated, pulmonary complications may develop in addition to septicemia and sepsis, which can result in organ failure, shock, and death. Boerhaave's syndrome has an overall mortality rate of 35%, but outcomes are highly dependent on fast and efficient treatment as mortality rates increase to 90% within 48 hours. 

Boerhaave’s Syndrome

Mallory Weiss tears refer to ruptures of the inner esophageal wall that sometimes extend into the upper stomach due to straining, often as a result of vomiting, coughing, or other trauma. Men between ages 40 and 60 who drink heavily are at the greatest risk, but patients with bulimia, conditions causing frequent vomiting, and/or esophageal conditions are also at increased risk. Symptoms include blood in vomit, dark stools, and dizziness and fainting due to blood loss and resulting anemia. Internal bleeding may also lead to shock. Though typically Mallory Weiss tears heal on their own or with the prescription of proton pump inhibitors, they sometimes requires endoscopic or surgical procedures.

Mallory Weiss Tears

Among those who vomit to purge, the acidity may damage the esophagus and esophageal sphincter, contributing to the potential development of Barrett's esophagus and esophageal adenocarcinoma. However, damage may be reversible with purging cessations, use of proton pump inhibitors (PPIs), and the prescription of metoclopramide to increase gastric emptying and aid in esophageal sphincter tone. Rarely, esophageal ruptures such as Boerhaave's syndrome and Mallory-Weiss tears may result, causing blood to appear in purged vomit.

Kalamazoo College

Bulimia nervosa is associated with numerous gastrointestinal issues. These issues can be divided into two main subsections:

- Upper gastrointestinal complications
- Lower gastrointestinal complications

Bulimia Nervosa Gastrointestinal Complications

Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343.

Medical Complications of Bulimia Nervosa

Bulimia Nervosa Upper Gastrointestinal Complications

Most lower gastrointestinal complications among bulimia nervosa patients are associated with the use of stimulant laxatives. Cathartic colon, colonic inertia, or rectal prolapse may arise, but symptoms should subside with cessation of laxative use, or replacement with osmotic laxatives. However, it is important to note that rectal prolapse may also result in anorexia nervosa patients due to malnutrition and the resultant weakening of the pelvic floor muscles. For unclear reasons, laxative use may also cause melanosis coli or blackening of the colon. 

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