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UEG Presentation

SCREENING FOR ARFID IN PATIENTS WITH GASTROINTESTINAL DISORDERS: A CALL FOR INTEGRATED CARE

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SCREENING FOR ARFID IN PATIENTS WITH GASTROINTESTINAL DISORDERS: A CALL FOR INTEGRATED CARE

Karen Routhiaux 1, Karen Van den Houte 1, Lukas Balsiger 2, Michael P. Jones 3, Karlien Raymenants 1, Cedric Van de Bruaene 1, Bert Broeders 1, Annelies Verheyden 1, Helen Burton Murray 4, Tim Vanuytsel 5, Jan Tack 5

Affiliations

1 KU Leuven, Leuven, Belgium

2 KU Leuven, Leuven, Belgium|||University of Bern, Bern, Switzerland

3 Macquarie University, North Ryde, Australia

4 Massachusetts General Hospital/Harvard Medical School, Boston, United States

5 KU Leuven, Leuven, Belgium|||UZ Leuven, Leuven, Belgium

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Abstract

Introduction

Avoidant/restrictive food intake disorder (ARFID) is characterized by reduced dietary intake leading to medical and/or psychosocial impairment, independent of body image concerns. Its prevalence in gastrointestinal (GI) disorders remains unclear despite frequent symptom-induced restrictive eating behaviors.

Aims & Methods

We aim to assess the prevalence and characteristics of ARFID in patients with various GI disorders compared to healthy volunteers (HV), and its associations with symptom severity, extraintestinal somatic symptoms and depression.
Data from 92 HV and 467 GI patients across seven tertiary care diagnostic categories —including irritable bowel syndrome (IBS, n=88), functional dyspepsia (FD, n=83), (refractory slow transit) constipation (n=59), reflux (n=107), globus (n=45), (non-obstructive) dysphagia (n=37), and achalasia (n=48)—were analyzed. Questionnaires included Rome IV criteria, ARFID screening, extraintestinal symptoms and depression scores (PHQ-12/9). Positive NIAS screening (NIAS+) was defined as meeting any subscale cutoff (≥10 for Picky Eating, ≥9 for Appetite, and ≥10 for Fear). Medical and/or psychosocial impairment in NIAS+ individuals was evaluated using the ARFID DSM-5 checklist. ARFID+ was defined as NIAS+ plus DSM-5 impairment. Odds ratios were calculated using a multiple logistic regression model with three-level hierarchical approach. Odds of fulfilling ARFID or NIAS criteria between DGBI diagnoses (step 1) were adjusted for z-scores of symptom severity (step 2) and extra-intestinal somatic symptoms and depression (step 3). Esophageal and non-esophageal disorders were analyzed separately.

Results

Table 1 shows demographics and characteristics of patients. Compared to HV, ARFID+ was significantly associated with IBS (OR: 15.00, p < 0.001), FD (OR: 10.59, p = 0.002), constipation (OR: 18.21, p < 0.001), dysphagia (OR: 7.03, p = 0.024) and reflux (OR: 5.16, p = 0.036), but not with achalasia and globus. Within disease categories, there were no differences in the odds of ARFID+ after adjusting for symptom severity (step 2) and for comorbid extraintestinal symptoms and depression (step 3). Increase in PHQ9, contributed independently to the presence of ARFID in non-esophageal disorders (OR: 1.11, p = 0.009).

		Non-Oesophageal			Oesophageal
Demographics	HV, N = 92	IBS, N = 88	FD, N = 83	Constipation, N = 59	Reflux, N = 107	Globus, N = 45	Dysphagia, N = 37	Achalasia, N = 48
Gender (% female)	57%	82%	86%	95%	54%	61%	60%	42%
Age (years)	38 (14)	33 (11)	38 (14)	46 (15)	48 (16)	52 (12)	52 (16)	54 (11)
BMI (kg/m²)	23.4 (21.0-25.4)	23.7 (20.4-26.3)	21.7 (19.7-23.8)	22.8 (20.7-25.3)	24.7 (22.2-27.4)	24.6 (21.0-27.7)	23.7 (21.4-28.2)	24.5 (22.4-26.3)
ARFID+	2 (2%)	22 (26%)	16 (19%)	17 (29%)	11 (10%)	4 (9%)	5 (14%)	5 (10%)
Model A step 1 Uncorrected vs. HV		15.00 (3.41–66.02)***	10.59 (2.36–47.61)**	18.21 (4.02–82.47)***	5.16 (1.11–23.90)*	4.29 (0.76–24.33)	7.03 (1.30–38.06)*	5.23 (0.98–28.06)
Model B step 1 Uncorrected vs. disease mean		0.051 (-0.36-0.47)	-0.297 (-0.74-0.14)	0.246 (-0.20-0.69)	-0.035 (-0.66-0.59)	-0.220 (-1.07-0.63)	0.275 (-0.53-1.08)	-0.020 (-0.81-0.77)
Model B step 2 Adjusted for Severity		-0.421 (-0.90-0.06)	0.066 (-0.45-0.59)	0.355 (-0.15-0.86)	-0.122 (-0.75-0.51)	-0.082 (-0.96-0.80)	0.227 (-0.60-1.05)	-0.023 (-0.82-0.77)
Model B step 3 Adjusted for Severity & Extraintestinal Symptoms and depression		-0.548 (-1.158, 0.061)	0.123 (-0.430, 0.677)	0.425 (-0.132, 0.982)	-0.163 (-0.848, 0.523)	-0.049 (-0.939, 0.842)	0.160 (-0.679, 1.000)	0.051 (-0.812, 0.914)

Table 1. Data are presented as n(%), mean(SD), median(IQR), or OR(95%). HV = Healthy Volunteers. Unadjusted ORs compare each disorder to HV (Model A). In Model B, each condition is compared to the disease mean within esophageal and non-esophageal groups. Negative values in adjusted models indicate log-odds differences from the group-specific disease mean. **p < 0.01, ***p < 0.001, ****p < 0.0001.

Conclusion

ARFID symptoms are prevalent across various GI disorders. While mechanical factors may drive ARFID in esophageal conditions, psychological factors (e.g., depression) may play a role in ARFID in non-esophageal disorders. Further research is needed to establish the contribution of mechanical factors to ARFID in esophageal conditions. Routine ARFID screening is crucial to address psychosocial and nutritional impacts in GI patients.

Event

UEG Week Berlin 2025

Topics

Immunology Neurogastroenterology & Motility Small Intestine & Nutrition Oesophagus Stomach & H. Pylori Colorectal

Submission format

Abstract

Session

Complexity and diversity in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Variable	Univariable regression	Multivariable regression
Variable	OR (95% CI)	p value	OR (95% CI)	p value
Female gender	1.661 (1.236–2.261)	< 0.001	1.519 (1.041–2.036)	0.028
Abdominal pain	0.354 (0.081–1.422)	0.451
Abnormal stool consistency	1.238 (1.033–1.521)	0.004	1.334 (1.022–2.551)	0.512
Bloating	1.433 (1.073–3.571)	0.031	0.889 (0.541–2.391)	0.093
Dyspepsia - Irritable bowel syndrome Overlap	4.442 (1.613–9.441)	< 0.001	2.056 (1.131–3.031)	0.031
Headache	2.117 (1.028–5.516)	0.029	0.615 (0.315–1.318)	0.044
Fatigue	4.117 (2.027–8.134)	< 0.001	1.073 (1.022–1.191)	0.012
Anxiety	2.724 (1.033–5.769)	0.018	1.992 (1.741–2.014)	0.037

UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

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