Avoidant/Restrictive Food Intake Disorder Is Common in Adult and Pediatric Patients with Celiac Disease and Non-Celiac Gluten Sensitivity

Background/Objectives: Avoidant/restrictive food intake disorder (ARFID), a non-body image-based eating disorder, has been described in several chronic gastrointestinal diseases, but little is known about ARFID in celiac disease (CeD) and non-celiac gluten sensitivity (NCGS). We aimed to identify the prevalence and characteristics of ARFID among adult and pediatric patients presenting for consultation of gluten-related disorders longitudinally. Methods: We reviewed 386 consecutive referrals (ages 2–82 y; 68% female) to a tertiary care celiac center from June 2019 to June 2022. Eligible patients had histologically confirmed CeD or were classified as NCGS based on gluten-related symptoms but negative serologies and histology. Masked coders applied DSM-5 criteria for ARFID at initial presentation and one-year follow-up visit. Results: Out of 386 patients, 253 had biopsy information and were included in the study. ARFID symptoms were present in 19% (47/253) of patients at consultation and in 17% (22/126) at follow-up. ARFID symptoms were equally present among patients with CeD and NCGS and were not associated with the presence or duration of a gluten-free diet, but patients with ARFID were more likely to be on a non-gluten-free diet at presentation. In multivariate analysis, the likelihood of having ARFID symptoms at consultation increased with a history of weight loss (OR 2.87, 95% CI 1.36–6.30). Conclusions: We found that almost one-fifth of patients with CeD and NCGS had symptoms of ARFID at consultation. At follow-up, among a smaller cohort, ARFID prevalence remained similar, although some patients no longer had ARFID symptoms, and some had new ARFID symptoms develop. Further longitudinal research is needed to understand the risk and maintenance factors of ARFID in the context of CeD and NCGS.