Avoidant/Restrictive Food Intake Disorder in the Adult Gastroenterology Population: An Under-Recognized Diagnosis?

Harer, Kimberly; Baker, Jason; Reister, Nerissa; Collins, Kristen; Watts, Lydia; Phillips, C R; Chey, William D.

doi:10.14309/00000434-201810001-00417

Cited by 16 publications

(21 citation statements)

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“…We found 52 patients (21.8%) met criteria for other FEDs driven by body shape/weight concerns (by n = 239 who completed the EDDS). This frequency is similar to other studies showing 23%‐28% eating disorder presence by self‐report among patients presenting for dysmotility evaluation or disorders of gut‐brain interaction 23‐25 . Dietary restriction, including fasting, to control body/shape weight is important to screen for, as twenty‐eight participants met criteria for eating disorders and endorsed restricting their diet, 5 of whom met criteria for anorexia nervosa.…”

Section: Discussionsupporting

confidence: 84%

“…Recently in the gastroenterology field, there has been increased interest in the overlap of ARFID with disorders of gut‐brain interaction (formerly called functional gastrointestinal disorders) 16 . ARFID symptoms have been reported between 19.6% and 23.7% among patients overall in neurogastroenterology and motility settings, 24,25,39 one of which used the same NIAS self‐report scale as in this study 24 . Importantly, the frequency of ARFID symptoms in the present sample was much higher (40%).…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…among patients overall in neurogastroenterology and motility settings, 24,25,39 one of which used the same NIAS self-report scale as in this study. 24 Importantly, the frequency of ARFID symptoms in the present sample was much higher (40%). This higher frequency converges with our retrospective chart review (N = 410) in which we found that likelihood of having ARFID symptoms was significantly increased by having diagnoses that involve dyspepsia/nausea/vomiting and/or abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

“…6,9,11 However, there is limited research on FED symptoms among gastroenterology populations. While some studies have identified a 23%-28% frequency of FEDs in adult patients presenting for dysmotility evaluation or disorders of gut-brain interaction, [23][24][25] no study to date has explicitly examined FED symptoms among a sample of patients with gastroparesis/ dyspepsia symptoms. To inform FED symptom detection, further research is needed to understand the frequency and nature of FED symptoms among patients with gastroparesis/dyspepsia symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Murray

Jehangir

Silvernale

et al. 2020

Neurogastroenterology Motil

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Introduction: Patients with symptoms of gastroparesis/dyspepsia often avoid foods or restrict eating for symptom management. There is growing interest in understanding risk for feeding/eating disorders (FEDs) like avoidant/restrictive food intake disorder (ARFID). Among patients presenting with gastroparesis/dyspepsia symptoms, we aimed to determine: (a) FED symptom frequency, and (b) relation of FED symptoms to gastrointestinal symptom severity and gastric retention abnormalities. Methods: Adult patients (N = 288; 78% female) referred for gastroparesis/dyspepsia symptoms at two academic medical centers from January 2018-February 2019 completed self-report surveys for gastrointestinal symptom severity and FED symptoms. Gastric retention data were available for 210 patients, using 4-hour EggBeater gastric emptying scintigraphy (GES). Results: Clinically significant FED symptoms were present in 158 patients (54.9%). Interestingly, 115 patients (39.9%) met conservative self-report cutoff for ARFID symptoms, with 67 (23.3%) patients having documented psychosocial/medical impairment. Of those with survey data for other FEDs (n = 239), only 28 patients (11.7%) had restrictive eating disorders (anorexia nervosa; unspecified FED). Likelihood of having FED symptoms was significantly associated with greater gastroparesis symptom severity (OR = 2.23, P < .001), but not GES. In addition, gastroparesis symptom severity was moderately and significantly associated with greater ARFID symptom severity (b = 0.45, P < .001), but neither GES nor other FED symptoms. Discussion: In patients presenting with gastroparesis/dyspepsia symptoms, FED symptoms were frequent (55%), particularly ARFID, and were associated with greater gastrointestinal symptom severity, but not gastric retention. Gastroparesis/ dyspepsia symptoms may mimic FEDs, particularly ARFID. Clinicians should be cautious about diagnosing ARFID in gastroparesis/dyspepsia patients, and screening for ARFID could assist behavioral treatment referral.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Murray

Jehangir

Silvernale

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

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Development of a brief cognitive‐behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut–brain interaction: Initial feasibility, acceptability, and clinical outcomes

Murray

Weeks

Becker

et al. 2022

Intl J Eating Disorders

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Background: Avoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with disorders of gut-brain interaction (DGBI), but treatments for this population (DGBI + ARFID) have yet to be evaluated.We aimed to identify initial feasibility, acceptability, and clinical effects of an exposure-based cognitive-behavioral treatment (CBT) for adults with DGBI + ARFID. Methods: Patients (N = 14) received CBT as part of routine care in an outpatient gastroenterology clinic. A two-part investigation of the CBT included a retrospective evaluation of patients who were offered a flexible (8-10) session length and an observational prospective study of patients who were offered eight sessions. Feasibility benchmarks were ≥75% completion of sessions, quantitative measures (for treatment completers), and qualitative interviews. Acceptability was assessed with a benchmark of ≥70% patients reporting a posttreatment satisfaction scores ≥3 on 1-4 scale and with posttreatment qualitative interviews. Mixed model analysis explored signals of improvement in clinical outcomes.Results: All feasibility and acceptability benchmarks were achieved (and qualitative feedback revealed high satisfaction with the treatment and outcomes). There were improvements in clinical outcomes across treatment (all p's < .0001) with large effects for ARFID fear (À52%; Hedge's g = 1.5; 95% CI = 0.6, 2.5) and gastrointestinal-specific anxiety (À42%; Hedge's g = 1.0; 95% CI = 0.5, 16). Among those who needed to gain weight (n = 10), 94%-103% of expected weight gain goals were achieved.Discussion: Initial development and testing of a brief 8-session CBT protocol for DGBI + ARFID showed high feasibility, acceptability, and promising clinical improvements. Findings will inform an NIH Stage 1B randomized control trial.

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Eating disorders: Understanding their symptoms, mechanisms, and relevance to gastrointestinal functional and motility disorders

Murray

Staller

Kuo

2023

Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions

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Avoidant/Restrictive Food Intake Disorder in the Adult Gastroenterology Population: An Under-Recognized Diagnosis?

Cited by 16 publications

References 0 publications

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis

Development of a brief cognitive‐behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut–brain interaction: Initial feasibility, acceptability, and clinical outcomes

Eating disorders: Understanding their symptoms, mechanisms, and relevance to gastrointestinal functional and motility disorders

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