Avoidant and restrictive food intake disorder among children with eosinophilic esophagitis

Children with eosinophilic esophagitis (EoE) may be at heightened risk for developing the eating disorder avoidant/restrictive food intake disorder (ARFID). However, relatively few studies have specifically looked at the prevalence of ARFID in children with EoE. The literature is plagued by varying diagnostic nomenclatures; existing studies have widely variable definitions of both ARFID and EoE. Finally, differentiating symptoms of EoE from those of ARFID can be challenging. The current study describes ARFID and its correlates in children ages 1-18 referred to a speciality EoE clinic.

One hundred and fifteen children participated in an observational, pilot study. All had confirmed diagnoses of EoE and were referred to a multidisciplinary EoE clinic for ongoing care. All completed questionnaires were collected at the time of the clinic visit.

Thirty-seven percent of patients met criteria for ARFID based on the Eating Disorders in Youth-Questionnaire and clinical interview. Seventy percent of children who were on food elimination only met criteria for ARFID, compared to 36% on medication only and 37% on combined food elimination and medication for EoE treatment. Children with food fussiness, a greater number of immunoglobulin E-mediated food allergies, and low enjoyment of food were more likely to have a comorbid ARFID diagnosis. Youth with EoE and ARFID had a lower quality of life.

A significant percentage of children with EoE referred to a multidisciplinary clinic struggle with the comorbid eating disorder ARFID. Routine screening and assessment should be considered to ensure adequate identification and intervention for this specific eating disorder.