Avoidant/restrictive food intake across the gastrointestinal tract

Avoidant/restrictive food intake disorder (ARFID) is characterized by reduced dietary intake leading to medical and/or psychosocial impairment, independent of body image concerns. We aim to assess ARFID screening and characteristics in patients with gastrointestinal disorders versus healthy volunteers (HV), and its associations with symptom severity, extraintestinal symptoms and depression scores.

We analyzed 92 HV and 467 patients from seven tertiary cohorts: irritable bowel syndrome (IBS, n=88), functional dyspepsia (FD, n=83), constipation (n=59), reflux (n=107), globus (n=45), dysphagia (n=37), and achalasia (n=48), grouped into non-esophageal (IBS, FD, constipation) and esophageal disorders (reflux, globus, dysphagia and achalasia). Assessments included Rome IV criteria, extraintestinal symptoms and depression scores (PHQ-12/9), and ARFID screening. ARFID+ was defined as NIAS+ (≥1 subscale cutoff: picky eating ≥10, appetite ≥9, fear ≥10) plus DSM-5 impairment. Odds ratios were derived from multiple logistic regression with three-level hierarchical approach adjusted for symptom severity, extra-intestinal, and depression symptoms.

Compared to HV, IBS (OR=15.0), FD (OR=10.6), constipation (OR=18.2), reflux (OR=5.2) and dysphagia (OR=7.0) were associated with ARFID+, whereas globus or achalasia were not. A higher prevalence of ARFID+ was observed in non-esophageal versus esophageal disorders (24% vs. 11%; OR=2.7, p<0.001), remaining significant after adjustments. Within non-esophageal disorders, depressive symptoms (OR=1.1) and food-related abdominal pain (OR=1.2) were independently associated with ARFID+, with fear-based food avoidance emerging as primary contributor to pain-related restrictive eating (β=0.3, p<0.001).

ARFID symptoms are more prevalent across non-esophageal disorders compared to esophageal disorders. Within non-esophageal disorders, symptoms severity and food-related abdominal pain are associated with ARFID+, and mostly characterized by fear of aversive consequences.