466 Avoidant/Restrictive Food Intake Disorder (ARFID) Among Adult Gastroenterology Behavioral Health Patients: Comparison of ARFID vs. Non-ARFID Patients

Abstract

INTRODUCTION: Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder characterized by avoidance or restriction of food associated with weight loss, nutritional deficiency, dependence on tube feeds/oral supplements, or significant psychosocial impairment. Emerging evidence has shown 6-19% of gastroenterology (GI) patients have concurrent ARFID; however, these patients have not been characterized. METHODS: Retrospective analysis of 223 adult GI patients seen by a gastroenterologist and GI psychologist at a tertiary care center from 2016 to 2018. ARFID diagnosis was based on chart review by a gastroenterologist and GI psychologist for evidence of DSM-5 ARFID criteria. Demographic, clinical, and questionnaire data were recorded. RESULTS: Of 223 patients, 28 (12.6%) met criteria for ARFID. Concern for ARFID was raised in 0% of cases. There was no difference between ARFID and non-ARFID patient gender, age, educational level, GI diagnosis, GI symptom severity, mean BMI, or frequency of nutrition referral (Table 1). ARFID patients were less likely to be using a psychotropic medication (17.9% vs 50%, P < 0.01). There was no difference in eating disorder history (ARFID 3.6% vs non-ARFID 8.7%, P = 0.12). On the IBS-QOL questionnaire, ARFID patients reported more severe food avoidance concerns, more frustration with not being able to eat what they wanted, and less severe body image concerns (all P< 0.5). Following completion of GI-directed psychological therapies, IBS-QOL scores improved less in ARFID patients (Table 2). There was no difference between groups in Brief Symptoms Inventory scores or sleep quality scores (Table 3). CONCLUSION: This is the first study comparing ARFID vs non-ARFID adult GI behavioral health patients. Of 223 patients, 12.6% met ARFID criteria. ARFID and non-ARFID patients were clinically indistinguishable based on age, gender, BMI, GI diagnosis, or GI symptom severity. Although ARFID is often associated by gastroenterologists with underlying psychiatric or eating disorders, ARFID patients were less likely to be using psychotropic agents, reported lower body image concerns, and reported increased frustration with not being able to eat than non-ARFID patients. ARFID patients had decreased improvement in post-behavioral health therapy IBS-QOL scores. This data demonstrates the need to appropriately screen patients for ARFID and raises concern regarding the need utilize a multidisciplinary treatment approach that takes into account GI, psychological, and nutritional needs.