Division of Gastroenterology.
Department of Psychology, Florida State University, Tallahassee, FL.
J Clin Gastroenterol. 2023 Aug 1;57(7):651-662. doi: 10.1097/MCG.0000000000001853.
High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
肠-脑相互作用障碍(DGBI)和饮食失调之间存在很高的重叠率,这两种疾病的共同干预措施在概念上存在冲突。在胃肠病学治疗环境中,人们越来越认识到不以体型/体重为中心的饮食失调,特别是回避/限制型食物摄入障碍(ARFID)。DGBI 和 ARFID 之间存在显著的共病性,表明其重要性,13%至 40%的 DGBI 患者符合 ARFID 的全部标准或具有明显的临床症状。值得注意的是,排除饮食可能使一些患者面临发展为 ARFID 的风险,而持续的食物回避可能会使先前存在的 ARFID 症状持续存在。在这篇综述中,我们向提供者和研究人员介绍了 ARFID,并描述了 ARFID 和 DGBI 之间可能存在的风险和维持途径。由于 DGBI 治疗建议可能使一些患者面临发展为 ARFID 的风险,我们提出了一些实用的治疗管理建议,包括基于证据的饮食治疗、治疗风险咨询和常规饮食监测。如果深思熟虑地实施,DGBI 和 ARFID 的治疗可以相辅相成,而不是相互冲突。
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