Delayed avoidant restrictive food intake disorder diagnosis leading to Ogilvie’s syndrome in an adolescent

Abstract

Purpose Avoidant restrictive food intake disorder (ARFID) was recently characterized, according to the DSM-5 classification, as a feeding and eating disorder (FED). However, ARFID remains poorly known by most pediatricians, but also by psychiatrists and primary care professionals. Despite the fact that patients with ARFID generally have a higher BMI than patients with anorexia nervosa, our purpose was to highlight the fact that they may present severe nutritional deficiencies and major somatic complications when the diagnosis is delayed. Method We describe here a case of a 16-year-old boy who presented with severe undernutrition (BMI = 11.5) leading to Ogilvie's syndrome, which resolved with enteral refeeding. Because of undernutrition, very bad dental condition, and encopresis, some physicians wrongly suspected child neglect, but retrospective analysis of his personal history revealed a longterm FED and sensory specificities that led to the final diagnosis of an ARFID-autism spectrum disorder (ASD) association. A literature review was conducted on the ARFID somatic complications. ConclusionThe training of health professionals in the clinical forms of pediatric FED, including ARFID, is necessary, to promote early diagnosis and prevent poor nutritional outcomes. In this case the association of ARFID-ASD and the delay in access to specialized care favored by the disadvantaged social environment led to severe gastrointestinal complications. Level of evidence V, descriptive study.

Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis

“… 52 Furthermore, our searches identified 22 individuals with ARFID suffering from severe micronutritional deficiencies which led to clinical disorders: xeropthalmia due to vitamin A deficiency 86 87 90 99 ; nutritional optic neuropathy due to vitamin B12 and folate deficiency 87 91 ; Wernicke encephalopathy due to vitamin B12 deficiency 43 ; severe osteoporosis due to vitamin D and/or vitamin B12 deficiencies 59 80 81 84 87 ; scurvy due to vitamin C deficiency 52 70 80 84 ; pulmonary artery hypertension from vitamin C deficiency 70 ; rickets due to vitamin D deficiency 81 and iron deficiency anaemia. 72 80 83 90 91 93 95 97 …”

Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome

“…Being autistic did not independently predict inadequate nutrition, but having a dual diagnosis did [6 ▪▪ ]. Because individuals with co-occurring ARFID and autism are particularly vulnerable to serious complications [22–29], enteral nutrition is particularly recommended for these individuals [6 ▪▪ ].…”

“…These include nutritional deficiencies [22], particularly vitamin C deficiency [22][23][24] and vitamin A, B12, E, and zinc deficiency [25]. In some situations, complications can be extreme, including osteopenia and compression fractures [25], severe undernutrition [26], acute intestinal pseudoobstruction (Ogilvie's syndrome) [26], optic neuropathy [27], rhabdomyolysis [28], pancytopenia [29], and cardiac arrest [24].…”

Analysis of feeding and eating disorders in 191 children according to psychiatric or gastroenterological recruitment: The PEDIAFED cohort study

“…In a recent study in children and adolescents (age range 0–17), patients with ARFID and AN were about 7.5 and 15 years old, respectively (Schmidt et al., 2022). A specific feature of ARFID is the lack of weight or body image concern and the high frequency of gastrointestinal symptoms (Bertrand, Dhenin, et al., 2022; Cooper et al., 2021; Fisher et al., 2014; Makhzoumi et al., 2019; Oliveira, 2021), and anxiety disorders in comparison with other FED (Fisher et al., 2014; Lieberman et al., 2019; Nicely et al., 2014; Norris et al., 2014).…”