Gastrointestinal symptomatology, diagnosis, and treatment history in patients with underweight avoidant/restrictive food intake disorder and anorexia nervosa: Impact on weight restoration in a meal‐based behavioral treatment program

Abstract

Objective Gastrointestinal (GI) concerns are often presumed to complicate nutritional rehabilitation for restrictive eating disorders, yet their relationship to weight restoration outcomes is unclear. This retrospective chart review examined GI history and weight‐related discharge outcomes in primarily adult, underweight inpatients with anorexia nervosa (AN, N = 107) or avoidant/restrictive food intake disorder (ARFID, N = 22) treated in a meal‐based, behavioral eating disorder program. Method Lifetime GI symptomatology, diagnoses, diagnostic tests, and procedures were abstracted from medical records. Generalized linear models examined associations of GI diagnoses, tests, and procedures with discharge BMI and rate of weight gain. Results Ninety‐nine percent of patients reported GI symptomatology and 83% had one or more GI diagnoses; with constipation and GERD most common. GI diagnoses (p <.01) and testing (p <.001) were more common in ARFID than AN. Average inpatient weight gain (1.59 kg/week), and discharge BMI (18.5 kg/m2), did not differ by group. Slower weight gain in patients with (1.3 kg/week), versus without (1.7 kg/week), history of tube feeding (p = .02), accounted for a main effect of GI procedures on inpatient rate of gain (p = .01). Discussion Despite ubiquitous GI symptomatology, meal‐based weight restoration achieved average weekly weight gain above recommended APA guidelines for hospitalized patients with an eating disorder. History of tube feeding was associated with slower mean weight gain, which remained, however, within recommended APA guidelines.

Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study

“…Most of these diagnoses related to the GI system. GI symptom burden in our study is less than that found in the study of Cooper et al (2021) of adult patients with ARFID, where all patients reported at least five GI symptoms (Cooper et al, 2021).…”

“…This is consistent previous studies of hospitalized patients (Makhzoumi et al, 2019; Strandjord et al, 2015). Cooper et al (2021) reported 41% of their cohort previously utilized enteral/parenteral nutrition (Cooper et al, 2021). Thus, use of enteral/parenteral nutrition preceding treatment may be similar between pediatric and adult populations with ARFID.…”

“…Few studies have explored the medical presentations in adults with ARFID. Cooper et al (2021) described GI symptoms/comorbidities in patients with ARFID presenting to inpatient ED treatment and reported 86% presented with constipation, 28% with GERD, 15% with gastroparesis, and 14% with irritable bowel syndrome (IBS) (Cooper et al, 2021). This study does not explore medical conditions outside of the GI organ system.…”

Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation

“…The "other" symptoms described in patients with a diagnosis of ARFID were often consistent with a low weight, such as cold intolerance, fatigue, and palpitations. For patients with an ARFID diagnosis, GI conditions (e.g., chronic abdominal pain and inflammatory conditions) were the most common co-occurring medical condition, consistent with chart reviews in adults with a diagnosis of ARFID (Cooper et al, 2021).…”

Aberrant gastric functioning in weight‐restored but not acute restricting‐type anorexia nervosa: An electrogastrography study

“…Altered interoception—one's sense of the body's physiological condition (Craig, 2002)—has therefore been proposed as a mechanism (Garner et al, 1983; Kaye et al, 2009, 2013) and is supported by neuroimaging findings (Berner et al, 2018; Holsen et al, 2012; Kerr et al, 2016; Strigo et al, 2013). Gastric interoception may be of central importance, due to both its relation to core symptomatology and because gastrointestinal (GI) symptoms are highly prevalent in individuals with AN (Boyd et al, 2010; Cooper et al, 2021) and may contribute to risk for eating disorders (Kerr et al, 2021).…”