Avoidant/restrictive food intake disorder in disorders of gut-brain interaction

Avoidant/Restrictive Food Intake Disorder (ARFID) is a disorder of food avoidance and/or restriction leading to medical or psychosocial consequences. Unlike other eating disorders, ARFID is not driven by shape or weight concerns but instead by three primary motivations: lack of interest or low appetite, fear of aversive consequences of eating, and sensory sensitivity. Increasing evidence highlights a bidirectional relationship between ARFID and disorders of gut-brain interaction (DGBI), with gastrointestinal (GI) symptoms precipitating restrictive eating patterns consistent with ARFID, and restrictive eating further exacerbating GI symptoms. Screening instruments such as the Nine-Item ARFID screen (NIAS) and the Pica, ARFID, and Rumination Disorder-Interview-ARFID Questionnaire (PARDI-AR-Q) may aid clinicians in identifying at-risk patients, but further work is needed to validate cutoff scores in patients with DGBI to distinguish adaptive dietary modification from excessive restriction. Management should involve multidisciplinary care between gastroenterologists, psychologists, and registered dietitian nutritionists (RDN). Medical management of GI symptoms, brain-gut behavioral therapies, and RDN-driven management of nutrition are arms of treatment that may be used individually or together to reduce restriction and expand dietary intake. In this narrative review, we aim to provide clinicians with a practical framework for identifying and managing ARFID in patients with DGBI.