Psychological Considerations in the Dietary Management of Patients With DGBI

Murray, Helen Burton; Doerfler, Bethany; Harer, Kimberly; Keefer, Laurie

doi:10.14309/ajg.0000000000001766

Cited by 19 publications

(18 citation statements)

References 32 publications

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“…Fear of aversive consequences has been consistently the most frequent ARFID presentation among DGBI samples (Burton Murray, Bailey, et al, 2020;Burton Murray, Jehangir, et al, 2020;Burton Murray, Riddle, et al, 2022) et al, 2004). We have proposed that treating ARFID in the context of DGBI may improve DGBI symptoms, as ARFID may perpetuate DGBI (Burton Murray, Doerfler, et al, 2022). One finding from our study in support of this model is that in the Part 2 study, the subscale with the largest improvements of gastrointestinal-related quality of life was the Diet/Food Habits-that is, decreased impact of DGBI symptoms on eating could lead to decreases in DGBI symptom severity.…”

Section: Discussionsupporting

confidence: 58%

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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Section: Discussionsupporting

confidence: 58%

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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“…Providers should consider screening patients' dietary histories closely, being mindful of self-initiated diets and preexisting fear or anxiety around food intake (see Chey et al 19 and Burton Murray et al for guidance). 68 Before recommending exclusion diets, providers should consider the psychological and nutritional effects, and consider the risk level of certain diets. 68 Ideally, exclusion diets should be implemented with dietitian guidance, and patients should be followed regularly to assess their response, and to determine when foods can be re-…”

Section: Ta B L Ementioning

confidence: 99%

“…68 Before recommending exclusion diets, providers should consider the psychological and nutritional effects, and consider the risk level of certain diets. 68 Ideally, exclusion diets should be implemented with dietitian guidance, and patients should be followed regularly to assess their response, and to determine when foods can be re-…”

Section: Ta B L Ementioning

confidence: 99%

History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review

Atkins

Zar-Kessler

Madva

et al. 2023

Neurogastroenterology Motil

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Background: Exclusion diets for gastrointestinal symptom management have been hypothesized to be a risk factor for avoidant/restrictive food intake disorder (ARFID; a non-body image-based eating disorder). In a retrospective study of pediatric and adult neurogastroenterology patients, we aimed to (1) identify the prevalence and characteristics of an exclusion diet history and (2) evaluate if an exclusion diet history was concurrently associated with the presence of ARFID symptoms. Methods:We conducted a chart review of 539 consecutive referrals (ages 6-90, 69% female) to adult (n = 410; January-December 2016) and pediatric (n = 129; January 2016-December 2018) neurogastroenterology clinics. Masked coders (n = 4) retrospectively applied DSM-5 criteria for ARFID and a separate coder assessed documentation of exclusion diet history. We excluded patients with no documentation of diet in the chart (n = 35) or who were not orally fed (n = 9).Results: Of 495 patients included, 194 (39%) had an exclusion diet history, and 118 (24%) had symptoms of ARFID. Of reported diets, dairy-free was the most frequent (45%), followed by gluten-free (36%). Where documented, exclusion diets were selfinitiated by patients/parents in 66% of cases, and recommended by gastroenterology providers in 30%. Exclusion diet history was significantly associated with the presence of ARFID symptoms (OR = 3.12[95% CI 1.92-5.14], p < 0.001). Conclusions: History of following an exclusion diet was common and was most oftenpatient-initiated among pediatric and adult neurogastroenterology patients. As patients with self-reported exclusion diet history were over three times as likely to have ARFID symptoms, providers should be cognizant of this potential association when considering dietary interventions. K E Y W O R D Savoidant/restrictive food intake disorder, disorders of gut-brain interaction, feeding and eating disorders, functional gastrointestinal disorders How to cite this article: Atkins M, Zar-Kessler C, Madva EN, et al. History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review.

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“…It is important for patients to be educated on proper diet implementation for both effectiveness and ARFID prevention. Many patients believe that certain foods 80 or food sensitivities 81 aggravate symptoms and may frequently self-initiate exclusion diets 30 . In addition, there are many diets without quality evidence of effectiveness that patients may know about, have already tried, or were recommended by previous providers.…”

Section: Preventing Arfid Development In Dgbimentioning

confidence: 99%

The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder

Weeks¹,

Abber

Thomas

et al. 2023

Journal of Clinical Gastroenterology

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High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.

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Psychological Considerations in the Dietary Management of Patients With DGBI

Cited by 19 publications

References 32 publications

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

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

History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review

The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder

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