(PS8-B42) Avoidant/restrictive Food Intake Disorder and Other Eating Disorder Symptoms in Patients with Chronic Constipation

Patients with chronic constipation often restrict their food intake (e.g., delay eating, follow food exclusion diets) in attempt to manage their symptoms. There is growing concern that a subset of patients may develop avoidant/restrictive food intake disorder (ARFID), but the rate of ARFID in patients with chronic constipation is unknown. Among adults with chronic constipation, we aimed to: (1) determine the frequency and characteristics of ARFID and (2) explore the relationship between ARFID symptoms and constipation symptom severity.

We included consecutive adult patients (N=116, 86% female, 85.3% identified as women, M_BMI=26, age range 18-85) referred for anorectal manometry for chronic constipation at an academic medical center. Patients met criteria for functional constipation (53%), irritable bowel syndrome (16%), or other constipation (31%). Patients completed self-report measures assessing for ARFID symptoms (Nine Item ARFID Screen with a psychosocial/medical impairment checklist; NIAS), other eating disorder symptoms (Eating Disorders Examination-Questionnaire 8-item; EDE-Q8), and constipation symptom severity (Patient Assessment of Constipation Symptoms; PAC-SYM). Definite ARFID was defined by a positive screen on at least one NIAS subscale (picky ≥10, interest ≥9, fear ≥10), presence of associated psychosocial impairment and/or medical consequences, and EDE-Q8 Global score < 2.3. Possible ARFID was defined by positive NIAS subscale screen and EDE-Q8 Global score < 2.3, but no endorsement of ARFID psychosocial or medical impairment. We also reported the rates of likely other eating disorder by EDE-Q8 Global score ≥4.0.

Nine (8%) patients had definite ARFID and an additional 45 (39%) had possible ARFID. Among those with definite or possible ARFID, cutoffs were met as follows: 46% NIAS-Picky; 61% NIAS-Interest; and 50% NIAS-Fear. Of those with definite ARFID, 50% reported weight loss, 20% nutritional deficiency, 20% dependence on supplemental nutrition, and 77% psychosocial impairment. Likely other eating disorder symptoms were present in 21 (18%). There were no significant differences in age, body mass index, or sex between those with ARFID symptoms (definite or possible) and those without. Total NIAS score was significantly associated with the abdominal subscale of the PAC-SYM and the fear subscale of the NIAS was significantly associated with both the abdominal subscale and total score on the PAC-SYM.

ARFID symptoms were common in patients with chronic constipation, and were positively associated with abdominal symptoms. Further research is necessary to determine the directionality of the relationship between fear around eating and abdominal symptoms.