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Anti-Nausea Drug Helps Bulimics

WebMD Health News

March 2, 2000 (Atlanta) -- A drug used to lessen the side effects of chemotherapy for cancer patients seems to help bulimic women reduce -- or even stop -- their cycle of binge eating and purging. Results of a small study reported Thursday indicate that the anti-nausea drug Zofran can reduce by half the number of binge/purge episodes in bulimic patients.

A larger study, which is now enrolling patients, must be completed before researchers can confirm whether the results are scientifically valid. But one of the 26 study participants says she doesn't need further proof.

"Within two days of taking the medicine, the symptoms disappeared -- after 12 years," the 27-year-old woman, who identified herself only as Cheryl, tells WebMD. "I did not have a reduction in symptoms; I had complete remission."

Study author Patricia L. Faris, PhD, stresses that Zofran (ondansetron) is no cure for bulimia. "I think it would be unconscionable to give the opinion that patients could come to our office and be cured," she tells WebMD. "I think what patients should be able to expect is several things. Maybe a restoration of their own self-respect: They don't have this problem because they are weak, but because they have a real physiological problem. They should also be able to expect help. With the watchful eye of a helpful physician, this is a viable treatment option."

Bulimia, like its sister eating disorder anorexia, involves a pervasive fear of weight gain. Bulimic patients, who are almost always female, develop a pattern of binge eating followed by self-induced vomiting. In the severe form of this disorder, bulimic patients binge and purge at least seven times each week. Currently, the best treatment is psychotherapy -- particularly a form known as cognitive-behavioral therapy, which seeks to normalize patients' eating habits and reduce their emphasis on weight. Antidepressant medications, such as Prozac (fluoxetine), also prove helpful.

The new study, the culmination of 10 years of work at the University of Minnesota, is based on a completely new theory about bulimia. Faris and colleagues suggest that constant bingeing and purging actually damages an important nerve -- the vagus, which controls the sensation of feeling full after eating.

"The disease starts off voluntarily," Faris says. "The women think, 'I can engage in binge eating and get away with it', but every time they vomit, that is a real jolt to the vagus, and the vagus gets used to this really intense stimulation. It then begins to cycle in patterns of increased activity. When activity in the vagus nerve becomes hyperactive, that is interpreted as the urge to engage in bulimic behaviors. A vicious cycle happens. You start out having ... control over it, but over time your binge frequency increases."

A commentary published with the study notes that there is no real way to prove this theory. But Angela S. Guarda, MD, director of the Johns Hopkins eating-disorder program, tells WebMD that the basic hypothesis appears sound. "I don't think it's totally off the wall," says Guarda, who was not involved in the study. "It is possible. Engaging in the behavior does create a physiological change that sustains the behavior."

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