Eating concerns in youth with functional abdominal pain disorders

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 79; no. 5; pp. 1040 - 1046
• Main Authors: Sim, Leslie, Ramachandran, Neha, Murad, Sammy T., Lebow, Jocelyn, Alexander, Erin, Johnson, Grace L., Harbeck‐Weber, Cynthia
• Format: Journal Article
• Language: English
• Published: United States 01-11-2024
• Subjects: adolescents; avoidant restrictive food intake disorder; chronic pain; eating disorders; exclusion diets; chronic pain; exclusion diets; avoidant restrictive food intake disorder; eating disorders; adolescents
• ISSN: 0277-2116; 1536-4801; 1536-4801
• DOI: 10.1002/jpn3.12377

Objectives
Adolescents with functional abdominal pain (FAP) often experience pain and other gastrointestinal symptoms in the context of eating, which may place them at risk for eating disorders. This study compared disordered eating and its sequalae in adolescents with FAP to those with chronic headache.
Methods
Participants in this retrospective chart review study were 270 adolescents and young adults (mean age 15.9; standard deviation [SD] = 1.63; 60% female) attending an intensive, interdisciplinary pain treatment program, including 135 youth with FAP and an age‐ and gender‐matched control group with a primary pain diagnosis of chronic headache. Information was extracted related to eating‐ and weight‐related symptoms.
Results
Independent t‐tests and χ2 analyses found that compared with adolescents with chronic headache, patients with FAP showed significantly more eating pathology as reflected by scores on the Eating Attitudes Test—26 (EAT‐26) (p < 0.001), endorsement of pain‐related restrictive eating (p < 0.01), eating disorder history (p < 0.001), and avoidant restrictive food intake disorder (ARFID) diagnoses (p < 0.001). Compared to those with chronic headache, significantly more patients with FAP had lost 10 pounds or more (p < 0.01) and a higher proportion were underweight (p < 0.001). Among all participants, a history of exclusion diets used to manage symptoms significantly increased the risk for ARFID (p < 0.001).
Conclusion
The results of this study highlight the increased risk of eating‐related concerns among youth with FAP, as well as the judicious use of exclusion diets to manage symptoms in these patients.
What is Known
Many adolescents with functional abdominal pain (FAP) alter their diet to manage symptoms which can place them at risk for eating disorders.
One eating disorder that may be prevalent among patients with FAP is avoidant restrictive food intake disorder (ARFID).
What is New
Youth with chronic headache and those with FAP show high rates of eating‐related pathology and elevated risk for ARFID.
The rates of eating disorders including ARFID in youth with FAP were significantly higher than those with chronic headache, as well as the general population.
In both youth with FAP and those with chronic headache, a history of exclusion diets was significantly related to receiving an ARFID diagnosis.