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. 2025 Sep;37(9):e70043.
doi: 10.1111/nmo.70043. Epub 2025 Apr 6.

Finding the Line Between Avoidant/Restrictive Food Intake Disorder and Refractory Disorders of Gut-Brain Interaction Using Lenient vs. Strict Severity Criteria: A Retrospective Exploratory Analysis From a Single Tertiary Neurogastroenterology Centre

Lee David Martin  1   2 , Asma Fikree  2   3 , Natalia Zarate-Lopez  2   3 , Karin Martinkova  3 , Concetta Brugaletta  2 , Chris Perrin  2 , Ursula Philpot  4
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Finding the Line Between Avoidant/Restrictive Food Intake Disorder and Refractory Disorders of Gut-Brain Interaction Using Lenient vs. Strict Severity Criteria: A Retrospective Exploratory Analysis From a Single Tertiary Neurogastroenterology Centre

Lee David Martin et al. Neurogastroenterol Motil. 2025 Sep.

Abstract

Background: Avoidant/restrictive food intake disorder (ARFID) is common among adults with disorders of gut-brain interaction (DGBI) presenting to gastroenterology settings. Symptoms overlap between ARFID and DGBI. How the severity of ARFID is defined can impact rates of diagnosis. Importantly, a diagnosis of ARFID can only be applied when the eating disturbance exceeds that expected from the DGBI condition. This leads to diagnostic challenges for the gastroenterology team. We aimed to explore how we could better identify "ARFID presentation" by reaching a clinically meaningful cut-off and distinct categories for separating DGBI from ARFID and where DGBI and ARFID overlap.

Methods: A retrospective review of electronic health records (EHR) was conducted on 33 patients 88% female (29/33), with a median age of 44.3 ± 15.5 (range 18-73 years). All had a Rome IV diagnosed DGBI and were refractory to standard medical care, requiring both gastro-psychology and dietitian input in a tertiary care Neurogastroenterology service during 2019. Severity criteria for meeting either strict or lenient ARFID criteria A were defined based on DSM-5 and best practice recommendations.

Results: The majority (82%) met a form of ARFID criteria A. However, by applying severity levels, 33% met criteria for strict ARFID, while 49% met lenient criteria, and 18% did not meet any criteria.

Discussion: Adults with refractory DGBI who require both dietetic and psychological support can meet both lenient and strict ARFID severity criteria. Future research should explore if utilizing severity markers can help separate the heterogeneity of DGBI + ARFID and inform diagnostic and treatment approaches.

Keywords: ARFID; DGBI; avoidant/restrictive food intake disorder; clinical practice; dietetics; disorders of gut–brain interaction; neurogastroenterology.

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