Vomiting and feeling fat--coincidence of achalasia and bulimia nervosa.

OBJECTIVE

In clinical practice it is often difficult to distinguish between organic and psychological vomiting.

METHODS

We present a case of a 34-year-old woman with an 18-month history of vomiting with the initial diagnosis of bulimia nervosa (BN). However, the patient showed an unusual vomiting behavior. Therefore, further somatic diagnostic procedures were carried out leading to the additional diagnosis of achalasia. After successful interventional and surgical treatment for achalasia, further psychotherapeutic interventions were necessary because of worsening of the BN symptoms. A certain disturbed eating behavior seemed to persist at 3-year follow-up, while the medical condition had improved.

CONCLUSIONS

It needs to be emphasized that careful diagnostic steps are indispensable to distinguish between psychological vomiting and organic vomiting. In case of two separate diseases a suitable treatment regime for each is required.