Finding the Line Between Avoidant/Restrictive Food Intake Disorder and Refractory Disorders of Gut–Brain Interaction Using... 2025 Martin et al

Full title: 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

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.

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Sorry to see this coming from my institution.
I looked up the definition of DGBI. It seems to be so vague that almost anything could quality:

The agreed-upon definition is as follows: functional GI disorders are disorders of gut–brain interaction. It is a group of disorders classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut micro- biota, and altered central nervous system (CNS) processing.

 

Might as well call it a tummy ache at this point..

 

Eric Idle: Hello doctor, I've got tummy ache. What is it then?

John Cleese: Well, Mr Idle, it seems that you have a serious refractory case of Gut Brain Interaction.

Eric Idle: Wassat?

John Cleese: Tummy ache.

Eric Idle: Gee, thanks doc, that's a weight off my mind.

John Cleese: Well, actually, it is more a weight off your brain, or on your brain, whichever way you want to look at it.

Eric Idle: Stop talking bollocks, doctor. Cheerio.

 

I'm going to be blunt here and say that no one requires gastro-psychology support. Just like no button soup actually requires a button. You can skip the thing entirely, it's just a cheap gimmick.