P0624 - GI-specific Anxiety, Not Generalized Anxiety or Depression, Linked to ARFID in Chronic Constipation

Akua Nuako, MD¹, Micaela Atkins, MD¹, Sophie Abber, MS², Victoria Beck, BA³, Jenna Clukey, BA³, Braden Kuo, MD, MSc, FACG³, Kyle Staller, MD, MPH³, Helen Burton-Murray, PhD^3
1Massachusetts General Hospital, Boston, MA; ²Florida State University, Tallahassee, FL; ³Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA

Introduction: Many patients with chronic gastrointestinal (GI) disease restrict food intake to manage symptoms. In adults with chronic constipation, constipation severity and GI-specific anxiety are associated with more traditional shape- and weight-motivated eating disorder (ED) symptoms, but the relationship to avoidant/restrictive food intake disorder (ARFID) is unknown. We aimed to (1) determine ARFID prevalence using a self-report survey and (2) identify possible risk/maintenance factors of ARFID in adults with chronic constipation.

Methods: We included 526 consecutive patients (80% female, mBMI=25, age 18-91) referred for anorectal manometry for chronic constipation at an academic medical center. Patients completed measures to assess ARFID symptoms using the Nine-Item ARFID Screen (NIAS) with a psychosocial/medical impairment checklist based on DSM-5 ARFID criteria, 8-item Eating Disorders Examination-Questionnaire (EDE-Q8) for other EDs, Hospital Anxiety and Depression Scale (HADS), Visceral Sensitivity Index (VSI) for GI-specific anxiety, and Patient Assessment of Constipation Symptoms (PAC-SYM) for symptom severity. We compared those with a negative screen on the NIAS to those with both a positive screen on at least one NIAS subscale and a negative screen for other ED symptoms (EDE-Q8 < 2.3).

Results: 179 (34%) patients screened positive for ARFID, 70 of whom also screened positive for another ED, leaving 109 (21%) in our analyzable ARFID group who had both a positive NIAS screen and a negative screen for other EDs (Table 1). Compared to those with a negative ARFID screen, those in our ARFID group had significantly more nutrition-related impairments. Groups did not differ in GI diagnoses, constipation symptom severity, generalized anxiety, or depression. On both univariate and multivariate analysis, lower BMI (OR=0.9; 95%CI=0.9-1.0) and higher GI-specific anxiety (OR=1.4 for every 10-point increase in VSI score; 95%CI=1.2-1.6) were significantly associated with a higher likelihood of being in the ARFID group.

Discussion: Screening positively on the NIAS for ARFID is common in patients with chronic constipation without other EDs (in 21%) and is associated with higher GI-specific anxiety, but not generalized anxiety, depression, or constipation severity. These findings suggest that GI-specific anxiety may be a convergent psychological risk/maintaining factor of ARFID in adults with chronic constipation, but future longitudinal research is needed.


Disclosures:


Akua Nuako, MD¹, Micaela Atkins, MD¹, Sophie Abber, MS², Victoria Beck, BA³, Jenna Clukey, BA³, Braden Kuo, MD, MSc, FACG³, Kyle Staller, MD, MPH³, Helen Burton-Murray, PhD³. P0624 - GI-specific Anxiety, Not Generalized Anxiety or Depression, Linked to ARFID in Chronic Constipation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.