The average age of the cohort was 39.1 years (SD: 11.7), ranging from 24 to 64 years, and 87% were female. The average %IBW and body mass index (BMI) on admission were 59.4% (SD: 6.4) and 12.7 kg/m2 (SD: 1.1), respectively. The cohort was comprised of 40% of patients diagnosed with AN-R, 33% with AN-BP, and 26.6% with ARFID.

Of the cohort, 7 (46.6%) underwent initial imaging with KUB, 7 (46.6%) with CT abdomen with contrast, and 1 (6.67%) with CT abdomen without contrast. Of the 7 patients who underwent initial imaging with KUB, 2 patients underwent further evaluation with CT scan of the abdomen with contrast. The decision to obtain further imaging with a CT scan was at the discretion of the attending physician treating the patient at the time acute gastric dilatation was diagnosed. The median day of the hospital stay during which the imaging procedure was obtained was day 7 (IQR: 4–17; range 0–32.) There was no difference in %IBW on the day of imaging between those who were diagnosed with acute gastric dilatation within the first week of admission versus those that were diagnosed with acute gastric dilatation after the first week of admission t(12) = 0.43, p = 0.67. The average BMI on the day the imaging study was performed, was slightly, but not significantly higher than the admission BMI, at 12.9 kg/m2t(12) = 1.25, p = 0.23. 93.3% of patients in the cohort were receiving at least one medication known to have the potential to slow gastrointestinal (GI) motility and 78.5% were on two or more of these medications. The most common medications were Zofran (92.8%), an opioid (47.8%), Hydroxyzine (35.7%), and Diphenhydramine (28.5%).

11 of the 15 patients (73.3%) were on 100% PO nutrition at the time of diagnosis of acute gastric dilatation. 2 patients (13.3%) were receiving 100% enteral nutrition (EN). 1 patient was receiving a combination of PO + EN. 1 patient was receiving total parenteral nutrition (TPN) and trickle tube feeds. On the day of diagnosis of acute gastric dilatation, 3 patients were on day one of a kcal increase, 2 patients were on day two of a kcal increase, and the remainder of the patients had been on their current kcal meal plan for greater than two days.

The average dilated stomach size was 20.5 cm (SD: 4.0; range 14–26.8.) There was no significant correlation of stomach size with any of the following: %IBW on day of admission, % IBW on day of imaging study, diagnosis of acute gastric dilatation within one week of admission versus after the first week of admission, rate of weight gain (kg per week), or duration of illness (all p’s > 0.05). Serum laboratory levels of sodium, potassium, phosphorus, magnesium, calcium, bicarbonate, blood urea nitrogen (BUN), glucose, albumin, and hematocrit, on the day of imaging, did not correlate with stomach size (all p’s > 0.05).

All patients in the cohort were treated with conservative management. Just over half the cohort (53.3%; n = 8) underwent suction via nasogastric (NG) tube and were given a period of bowel rest. Suction was continued in most patients for about 24 to 72 h. Nutrition was reintroduced through clear liquid diet and then advanced back to a regular diet as tolerated. Half of the patients undergoing suction via NG tube were also started on TPN for nutrition support. At discharge, patients were on a PO diet or a combination of PO + EN diet. No patient required TPN at the time of discharge. None of the patients in the cohort underwent surgical intervention for their acute gastric dilatation.

Four of the fifteen patients (26.6%) did not undergo follow-up abdominal imaging with KUB or CT scan of the abdomen after being diagnosed with acute gastric dilatation. Of the eleven patients who did undergo follow-up abdominal imaging, eight patients (53.3%) had no evidence of gastric dilatation on subsequent imaging, one patient (6.6%) had continued gastric dilatation, one patient (6.6%) had probable gastric dilatation, and in one patient (6.6%) the radiologist was unable to accurately comment on stomach size due to massive ascites. However, all of these patients ultimately were able to continue their weight restoration without ongoing evidence of persistent acute gastric dilatation.