Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut‐brain interaction

Abstract

Background Previous studies show some patients with functional gastrointestinal disorders (disorders of gut‐brain interaction) may be at risk for or already have an eating disorder (ED). Avoidant/restrictive food intake disorder (ARFID) (ED not primarily motivated by body shape/weight concerns) may be particularly relevant but previous studies have been unable to fully apply diagnostic criteria. This study aimed to determine the frequency and nature of the full spectrum of ED symptoms, among adults with disorders of gut‐brain interaction. Methods Adults with disorders of gut‐brain interaction (n = 99, 77.1% female, ages 18–82 years) from academic medical center gastroenterology clinics completed a modified ARFID Canadian Paediatric Surveillance Program Questionnaire, the ED Examination Questionnaire (EDE‐Q), and other self‐report measures of depression, generalized anxiety, and pain interference. Key Results Of the 93 participants who completed the measures, 37 (39.8%) had ARFID symptoms and 12 (12.9%) had clinically significant shape/weight‐motivated ED symptoms (EDE‐Q‐Global ≥4.0). Exploratory comparisons among ARFID, shape/weight‐motivated ED, and no‐ED groups revealed that ARFID symptom presence was associated with lower body mass index (BMI), and shape/weight‐motivated ED presence was associated with higher depression, anxiety, and pain interference. However, the majority (86%) of patients with ARFID symptoms had a BMI >18.5 kg/m2. Conclusions & Inferences The full spectrum of ED symptoms was frequent among patients with disorders of gut‐brain interaction, particularly ARFID symptoms. Further research is needed to understand risk and maintenance factors to inform prevention and intervention efforts.

Orthorexia nervosa is a concern in gastroenterology: A scoping review

“…Based on the findings of this review and the findings from Burton Murray et al and Peters et al, 19,20 prior to prescription of any restrictive dietary therapy, clinicians should be aware of orthorexia and other forms of disordered eating, and consider if a restrictive diet is appropriate, as shown in the clinical flowchart in Figure 2 93 . Burton Murray et al recommend that clinicians should screen patients for problematic eating patterns and shape/weight‐motivated eating disorders 19 .…”

“…Based on the findings of this review and the findings from Burton Murray et al and Peters et al, 19,20 prior to prescription of any restrictive dietary therapy, clinicians should be aware of orthorexia and other forms of disordered eating, and consider if a restrictive diet is appropriate, as shown in the clinical flowchart in Figure 2 93 . Burton Murray et al recommend that clinicians should screen patients for problematic eating patterns and shape/weight‐motivated eating disorders 19 . Short screening questionnaires may be implemented to identify potentially at‐risk patients 94 such as the five item Sick, Control, One stone, Fat, Food (SCOFF) questionnaire, 95 although this questionnaire has not been validated in gastroenterology 96 .…”

“…The studies by Burton Murray et al and Peters et al published in this issue of Neurogastroenterology and Motility, both highlight the high prevalence of disordered eating behaviors in patients with gastrointestinal conditions, particularly DGBIs 19,20 . Burton Murray et al reported 40% of DGBI patients had ARFID, with the most frequent presentation being fear of adverse consequences 19 . The systematic review by Peters et al reported disordered eating in 13%–55% of patients with gastrointestinal disorders, with highest prevalence in those with DGBI 20 .…”

“…Recent studies investigating ARFID in irritable bowel syndrome (IBS) have shown those with severe food avoidance and restriction have more severe symptoms overall, reduced quality of life and reduced nutrient intake 18 . The studies by Burton Murray et al and Peters et al published in this issue of Neurogastroenterology and Motility, both highlight the high prevalence of disordered eating behaviors in patients with gastrointestinal conditions, particularly DGBIs 19,20 . Burton Murray et al reported 40% of DGBI patients had ARFID, with the most frequent presentation being fear of adverse consequences 19 .…”

Immune Activation in Functional Dyspepsia: Bystander Becoming the Suspect

“…Indeed, also allergy-independent mechanisms can provoke bothersome reactions as, e.g., spicy food intake was linked to fullness and retching symptoms in FD patients, irrespective of TRPV1 genotype ( Lee et al, 2016 ). As a consequence, the burden imposed by food-related reactions can be enormous with an alarming rate of 39.8% (37/93) of DGBI patients reporting symptoms of avoidant or restrictive food intake disorders (ARFID), which could be triggered or worsened by dietary restrictions as part of (self-initiated) therapy ( Burton Murray et al, 2021 ).…”