Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms in Adolescent Patients With Disorders of Gut-Brain Interaction.

Abstract

Objective: Disorders of gut-brain interaction (DGBI) and avoidant/restrictive food intake disorder (ARFID) share clinical characteristics. However, research on the prevalence of ARFID symptoms in youth with DGBI and the clinical presentation of DGBI youth with varying levels of ARFID symptoms is limited.

Method: In this cross-sectional observational study, 38 adolescents (range 12-17 years; 71% female) with a diagnosed DGBI receiving treatment at a pediatric gastroenterology clinic and a primary caregiver completed the Nine Item ARFID Screen (NIAS). Gastrointestinal (GI), psychiatric, quality of life (QOL), and weight/growth outcomes were assessed via youth- and caregiver-reported questionnaires, anthropometrics, and a water load test. ARFID symptoms were characterized, and their associations with GI, psychiatric symptoms, QOL, and weight/growth outcomes were analyzed.

Results: Clinically significant ARFID symptoms were reported by 42% of youth and 55% of caregivers. ARFID symptoms were associated with more severe GI and psychiatric symptoms, lower QOL, and clinically significant weight loss or faltering growth. While associations became non-significant after false discovery rate correction, the effect sizes were medium to large, clearly demonstrating meaningful associations. Agreements between youth and caregiver NIAS reports were good to excellent.

Discussion: ARFID symptoms are common in adolescents with DGBI and associated with clinical severity. Further elucidating this common co-morbidity and developing guidelines for effective co-management are priorities.