High prevalence of avoidant/restrictive food ıntake disorder and psychiatric comorbidities in pediatric eosinophilic...

This study aimed to evaluate the prevalence and subtypes of avoidant/restrictive food intake disorder (ARFID) as well as other psychiatric comorbidities in children and adolescents diagnosed with eosinophilic esophagitis (EoE). In this cross-sectional study, 29 children and adolescents (24 males, 82.8%) with EoE and 61 healthy controls (HC; 30 males, 49.2%) were included. The clinical group was recruited from a pediatric gastroenterology outpatient clinic, while the HC group was recruited from an outpatient child and adolescent psychiatry clinic, where participants were evaluated and found to have no psychiatric or somatic disorders after thorough assessment.All participants underwent structured diagnostic interviews. They also completed the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen-Self-Report, Revised Child Anxiety and Depression Scale, and Children's Eating Attitudes Test-26, while parents completed the NIAS-Parent Report, State-Trait Anxiety Inventory-Trait and State Form, Beck Depression Inventory, and Eating Disorder Examination Questionnaire-Short Form. ARFID was observed in 70.8% of the EoE group, a significantly higher rate than in the HC group (29.2%) (p < 0.001). Among EoE patients, the picky eating and appetite subtypes were more frequent, while the fear subtype was observed only in this group. Psychiatric comorbidities were also more prevalent in participants with EoE (70.3%) compared with HC (29.7%) (p < 0.001). Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, such as separation anxiety, social phobia, school phobia, generalized anxiety, and panic disorder, were significantly more common in EoE compared to the HC group (p < 0.05).

Children and adolescents diagnosed with EoE appear to have a significantly increased risk for ARFID and other psychiatric comorbidities, especially ADHD and anxiety disorders. Regular multidisciplinary follow-up, including child psychiatry involvement, is essential for comprehensive assessment and management of these patients.

• Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus, frequently associated with feeding difficulties and restrictive eating behaviors. • Avoidant/restrictive food ıntake disorder (ARFID) is increasingly recognized in EoE, but data on its prevalence and psychiatric comorbidities in pediatric populations remain limited.

• Children with EoE showed markedly higher rates of ARFID, attention-deficit/hyperactivity disorder, and anxiety than healthy peers. • The NIAS-PR total score showed excellent discrimination in identifying ARFID, supporting its robust clinical utility for screening in pediatric gastroenterology practice.