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.

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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.

Bulimia Nervosa Upper Gastrointestinal Complications

Bulimia nervosa patients may suffer from conjunctival hemorrhages and nose bleeds due to gagging and retching during self-induced vomiting. Furthermore, the acid in vomit may cause damage to the throat, contributing to hoarseness, coughing, dysphagia, and pharyngitis, although these symptoms can usually be treated simply by purging cessation, or through the use of proton pump inhibitors (PPIs). Sialadenosis occurs in over half of those who purge via self-induced vomiting, though it typically goes away on its own with continued cessation of purging behaviors.

Bulimia Nervosa Head/Ear/Nose/Throat Complications

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

Proton Pump Inhibitors (PPIs): What They Are & Side Effects. (2023, September 28). Cleveland Clinic. Retrieved February 15, 2024, from https://my.clevelandclinic.org/health/articles/proton-pump-inhibitors

Proton Pump Inhibitors (PPIs): What They Are & Side Effects

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

Sialosis or sialadenosis refers to the hypertrophy of the parotid and salivary glands. It often occurs in bulimia nervosa patients after several days of cessation of self-induced vomiting. Though it typically goes away with continued cessation, it can also be treated through sour foods to induce salivation, heating pads, NSAIDs, and sometimes pilocarpine if other treatments are ineffective. 

Sialosis (Sialadenosis)

Dysphagia is a medical term which refers to difficulty swallowing. 

Dysphagia

Subconjunctival hemorrhages refers to the bursting of blood vessels in the eye, often due to straining or injury but sometimes as a result of certain medications or medical conditions. Typically, they are asymptomatic and do not require medical treatment.

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