272 – Avoidant/Restrictive Food Intake Disorder Among Adult Gastroenterology Behavioral Health Patients: Demographic and Clinical Characteristics

Harer, Kimberly; Jagielski, Christina H.; Riehl, Megan E.; Chey, William D.

doi:10.1016/s0016-5085(19)36916-1

Cited by 17 publications

(32 citation statements)

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“…Of concern, in >70% of patients who screened positive for ARFID, a low-FODMAP diet was recommended by their GI provider who was unaware of the screening survey results. 125 Although an ARFID screening questionnaire is available, it has yet to be validated in patients with GI conditions. 126 The development and validation of such a GI-specific screening tool will be important to help providers to identify patients who should avoid restrictive diets.…”

Section: Implementation Of Low-fodmap Dietmentioning

confidence: 99%

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome

et al. 2021

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Irritable bowel syndrome (IBS) is a common, symptombased condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-thecounter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.

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Section: Implementation Of Low-fodmap Dietmentioning

confidence: 99%

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome

et al. 2021

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“…Harer et al (2019) found complaints of reflux in 10.7% of patients with ARFID, although 28.6% of this sample had been previously diagnosed with GERD. Similarly, Murray et al (2020) found fewer esophageal complaints in those diagnosed with ARFID compared to healthy controls ( p = .022), although these esophageal complaints were not further defined.…”

Section: Resultsmentioning

confidence: 72%

“…Similarly, in a sample of 410 patients referred to a neurogastroenterology center, individuals meeting criteria for ARFID ( n = 97) reported a significantly increased number of gastric complaints compared to those without ARFID ( n = 313) ( p = .001) (Murray et al, 2020). However, Harer et al (2019) found only two of 28 patients, meeting criteria for ARFID (7.1%), to have a previous diagnosis of gastroparesis—although 28.6% reported nausea/vomiting, 7.1% reported early satiety, 35.7% reported bloating, and 78.6% reported abdominal discomfort.…”

Section: Resultsmentioning

confidence: 99%

“…Slow colonic transit is known to develop in the setting of AN (Table 4), and nearly 50% of individuals with ARFID reported constipation in one study (Harer et al, 2019). Chun et al (1997) found that four of six patients with AN had slow colonic transit when studied early in their hospitalization, and zero of seven separate patients with AN, studied 3 weeks after the initiation of their hospitalization, had slow colonic transit.…”

Section: Resultsmentioning

confidence: 99%

“…Research suggests that GI symptoms can predispose to disordered eating (Conviser, Fisher, & McColley, 2018; Kaluski, Natamba, Goldsmith, Shimony, & Berry, 2008; Wiklund et al, 2019), which can then evolve into a full threshold ED (Chamay‐Weber, Narring, & Michaud, 2005). In addition, individuals meeting criteria for avoidant restrictive food intake disorder (ARFID) present with a significant number of GI complaints that can be the motivation for continued restrictive eating (Harer, Jagielski, Riehl, & Chey, 2019; Murray et al, 2020). Although GI symptoms presumably contribute toward disordered eating, and physiologic changes to the GI system develop as a direct consequence of malnutrition, the actual cause of many GI symptoms in this population, as well as their long‐term contribution to on‐going disordered eating and weight loss, remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Gibson

Watters

Mehler

2021

Intl J Eating Disorders

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Objective Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating. Methods Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review. Results A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. Discussion Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.

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Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study

Nitsch

Watters

Manwaring

et al. 2023

Intl J Eating Disorders

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Objective: The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population.Method: We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission.Results: One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI).

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272 – Avoidant/Restrictive Food Intake Disorder Among Adult Gastroenterology Behavioral Health Patients: Demographic and Clinical Characteristics

Cited by 17 publications

References 0 publications

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome

The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review

Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study

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