Avoidant-Restrictive Food Intake Disorder in Patients With Gastrointestinal Disorders: A Systematic Review

Avoidant-restrictive food intake disorder (ARFID) is an eating disorder diagnosis implemented with DSM-5 in 2013. Elevated risk for ARFID in patients with gastrointestinal disorders is suggested. This systematic review explored (1) methods used to identify patients with gastrointestinal disorders and comorbid ARFID and (2) their clinical characteristics.

Following the PRISMA guidelines, Medline/PubMed, Embase, PsycInfo and CINAHL were searched for studies from January 2000 to December 2025 and a narrative analysis of the systematically extracted data was performed.

Twenty-three studies with a total of 6211 participants were included. Studies were primarily observational with retrospective chart reviews or self-reported surveys. Twenty studies were conducted in tertiary gastroenterology clinics, primarily covering disorders of gut-brain interaction. Four studies focused on paediatric populations, 18 on adults and one included both. Participants were predominantly female, aged 6-90 years. ARFID case identification was heterogeneous regarding both data collection method, application of diagnostic criteria and diagnostic tool. ARFID symptoms were most consistently reported, with fear of aversive consequences, such as fear of abdominal pain, nausea or vomiting, being the most dominant. The negative consequences of ARFID symptoms were less consistently described.

Literature on ARFID in gastrointestinal populations has increased in recent years. However, inconsistent identification of ARFID cases may lead to an overestimation of ARFID prevalence among patients with gastrointestinal disorders. Longitudinal studies with full diagnostic criteria applied are needed to better understand the prevalence and presentation of ARFID in gastrointestinal populations.