Avoidant/restrictive food intake disorder prevalence is high in children with gastroparesis and functional dyspepsia

Authors: KAUL, ISHA - Children'S Nutrition Research Center (CNRC); BURTON-MURRAY, HELEN - Harvard Medical School; MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); MIRABILE, YIMING - Children'S Nutrition Research Center (CNRC); CZYZEWSKI, DANITA - Baylor College Of Medicine; VAN TILBURG, MIRANDA - University Of North Carolina; SHER, ANDREW - Baylor College Of Medicine; CHUMPITAZI, BRUNO - Duke University School Of Medicine; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/26/2024
Publication Date: 5/1/2024
Citation: Kaul, I., Burton-Murray, H., Musaad, S., Mirabile, Y., Czyzewski, D., Van Tilburg, M.A., Sher, A.C., Chumpitazi, B.P., Shulman, R.J. 2024. Avoidant/restrictive food intake disorder prevalence is high in children with gastroparesis and functional dyspepsia. Neurogastroenterology & Motility. 36(5). Article e14777. https://doi.org/10.1111/nmo.14777.
DOI: https://doi.org/10.1111/nmo.14777

Interpretive Summary: Slow stomach emptying (gastroparesis) often causes multiple severe symptoms including belly pain, vomiting, loss of appetite, and weight loss that affects children and adults and lasts for years. Another condition, called functional dyspepsia, can cause similar symptoms. Because eating can worsen symptoms in both of these conditions, changes to what people eat, how often they eat, and how much they eat often are recommended. People who are affected by these conditions may begin to fear eating because of worry that their symptoms will worsen. This can lead to a condition where they unnecessarily limit how much they eat. As a result, they can lose weight and become malnourished. In this study, we found that many children with slow stomach emptying or functional dyspepsia unnecessarily avoid eating. Knowing this will change the approach we use in dealing with children with these two conditions.

Technical Abstract: Avoidant/restrictive food intake disorder (ARFID) prevalence in children with gastroparesis (Gp) and/or functional dyspepsia (FD) is unknown. We aimed to identify ARFID prevalence and trajectory over 2 months in children with Gp, FD, and healthy children (HC) using two screening questionnaires. We also explored the frequency of a positive ARFID screen between those with/without delayed gastric emptying or abnormal fundic accommodation. In this prospective longitudinal study conducted at an urban tertiary care hospital, patients ages 10–17 years with Gp or FD and age- and gender-matched HC completed two validated ARFID screening tools at baseline and 2-month follow-up:the Nine Item ARFID Screen (NIAS) and the Pica, ARFID, and Rumination Disorder Interview-ARFID Questionnaire (PARDI-AR-Q). Gastric retention and fundic accommodation (for Gp and FD) were determined from gastric emptying scintigraphy. At baseline, the proportion of children screening positive for ARFID on the NIAS versus PARDI-AR-Q was Gp: 48.5% versus 63.6%, FD: 66.7% versus 65.2%, HC: 15.3% versus 9.7%, respectively; p < 0.0001 across groups. Of children who screened positive at baseline and participated in the follow-up, 71.9% and 53.3% were positive 2 months later (NIAS versus PARDI-AR-Q, respectively). A positive ARFID screen in Gp or FD was not related to the presence/absence of delayed gastric retention or abnormal fundic accommodation.