Disorders of gut-brain interaction (DGBI), previously known as functional gastrointestinal disorders, are among the most common gastrointestinal (GI) diagnoses worldwide, contributing significantly to morbidity and reduced quality of life [1]. Recent estimates suggest a global prevalence of DGBI as high as 40 % [2]. Patients with DGBI often attribute their symptoms to food, and self-reported food intolerances are associated with greater GI symptom severity and reduced quality of life [3]. Over the past 5 years, there has been growing concern about a subset of patients with DGBI developing significant food avoidance/restriction leading to medical or functioning issues, technically meeting criteria for Avoidant/Restrictive Food Intake Disorder (ARFID) [4,5]. And more recently, treatment guidelines have specifically recommended that ARFID be screened for in some DGBI populations [6].

ARFID is characterized by restrictive eating, such as insufficient caloric intake or significant limitations in dietary variety, which is not driven by concerns about body shape or weight. Instead, restrictive eating in ARFID stems from lack of interest in eating, sensory sensitivities (e.g., food neophobia or disgust reaction to food texture or smell), and/or fear of aversive consequences related to food intake (e.g., fear of vomiting, choking) [7]. To be diagnosed with ARFID, restrictive eating cannot be fully explained by another medical, including GI, or psychiatric condition, and must have clinical consequences, such as nutritional deficiencies, supplement dependence, weight loss, or psychosocial impairment [8,9]. ARFID prevalence is estimated to be between 4 and 11 % of the general population [9]. In adults with DGBIs, prevalence is higher, with almost 20 % of adult patients screening positively for ARFID on self-report questionnaires [10] and around 24 % demonstrating some ARFID symptoms via retrospective chart review, with 6 % having psychosocial or medical consequences of restriction [11]. Among adult patients with DGBI, restrictive eating has most commonly been motivated by fear of aversive consequences of eating, with or without lack of interest in eating, rather than due to sensory sensitivities [12]. For clinicians, distinguishing ARFID from reasonable or expected dietary modifications can be difficult [13], as many patients with DGBI successfully manage symptoms with self-initiated or prescribed dietary therapies.

The aim of this narrative review is to support the identification and management of ARFID in patients with DGBI in the clinical gastroenterology setting. We will describe diagnostic strategies and considerations when assessing for ARFID in patients with DGBI and use case-based examples to highlight key concepts in education and treatment of ARFID in this patient population.