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


Harer, Kimberly MD1; Baker, Jason PhD1; Reister, Nerissa2; Collins, Kristen1; Watts, Lydia BS1; Phillips, Cari BS1; Chey, William D. MD, FACG1

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American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S247-S248
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Introduction: Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder characterized by avoidance or restriction of foods associated with clinically significant weight loss, nutritional deficiency, dependence on tube feeds/oral supplements, or significant psychosocial interference. Unlike eating disorders, body dysmorphia is not present. Although well described in children, limited ARFID data is available among adults. We hypothesize ARFID is an under-recognized disorder among adult gastroenterology (GI) patients.

Methods: The Nine Item ARFID Screen (NIAS) was prospectively administered to adult general GI and motility outpatients at a tertiary care center. The NIAS is a 9-item, Likert scale questionnaire that inquires about picky eating, interest in food, and eating habits driven by a fear of negative consequences. Responses range from strongly disagree (0 points) to strongly agree (5 points). A score of ≥ 24 was considered a positive ARFID screen. Statistical analysis included chi square and univariate/multivariate regression analyses.

Results: Of the 317 patients, 65.6% of patients were female, and 78.6% of patients were Caucasian. Other patient demographic and clinical characteristics are outlined in Table 1. Sixty-two (19.6%) patients had a positive ARFID screen. Univariate logistic regression analyses demonstrated associations between a positive ARFID screen and abdominal pain, nausea/vomiting, constipation, diarrhea, dysphagia, fatigue, and Irritable Bowel Syndrome (IBS) (all p < 0.03). Nausea/vomiting (OR 3.3, p < 0.01), dysphagia (OR 2.24, p = 0.04), and IBS (OR 2.06, p = 0.04) remained statistically significant in the multivariate analyses. Fear of food reintroduction, number of GI symptoms, and weight loss of 10 or more pounds were associated with a positive ARFID screen (all p < 0.001). Among patients with a positive screen and weight loss, IBS patients had a higher mean weight loss compared to non-IBS patients (37.5 vs 18.4 pounds, p = 0.049). IBS patients with a positive screen also had a higher mean number of GI symptoms compared to non-IBS patients (5.4 vs 3.9, p < 0.01).

Conclusion: This is the first large, prospective study screening adult gastroenterology patients for ARFID. The 19.6% positive ARFID screen risk identified in this study provides evidence that ARFID complicates the clinical presentation of patients with a wide range of GI disorders. This data suggests ARFID may be an under-recognized disorder among adult GI patients.

417 Figure 1 No Caption available.
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