Screening of Avoidance/Restrictive Food Intake Disorder (ARFID) in patients with quiescent inflammatory bowel disease and irritable bowel syndrome-like symptoms

Purpose Even in the absence of active inflammation, patients with inflammatory bowel diseases (IBD) frequently report symptoms consistent with irritable bowel syndrome (IBS), which may lead to restrictive dietary patterns and ultimately increase the risk of Avoidant/Restrictive Food Intake Disorder (ARFID). The aim was to evaluate the prevalence of patients at risk of ARFID among individuals with quiescent IBD and IBS-type symptoms, and to evaluate its association with the FODMAP intake. Methods A cross-sectional study was conducted on adult IBD patients followed in a tertiary Belgian center whose recent work-up showed endoscopic and biological remission as per STRIDE II criteria. Self-administered questionnaires (NIAS-Fr, SCOFF-F, FFQ-FODMAP-BE, GAD-7, PHQ-9, IBS SSS, PRO-2, HBI) were completed remotely via REDCap. Univariate and multivariate logistic regressions were performed, with the significant threshold fixed at 5%. Results Sixty-two patients were enrolled (65% female, 66% Crohn’s disease, mean age 39 ± 14 years). Overall, 16 patients (26%) were screened positive for ARFID risk. Among these 16 patients, the distribution across subscales (picky eater, small appetite, fear of eating) was as follows: 63% (10/16) fulfilled one subscale, 31% (5/16) fulfilled two subscales, 6% (1/16) fulfilled all three. Higher IBS symptom severity was associated with a higher risk of positive screening for ARFID. In a multivariate logistic regression model, positive screening for risk of ARFID was associated with mild FODMAP consumption (FFQ-FODMAP-BE < 1.80) and anxiety. Conclusion One in four patients with quiescent IBD has a positive screening for ARFID. Anxiety and low FODMAP intakes are associated with positive screening.