LBA3 Is there a connection between having coeliac disease and developing avoidant restrictive food intake disorder?

Is there a connection between having Coeliac Disease and developing ARFID?Coeliac Disease in an autoimmune disease with 1 in 100 members of the population being affected.1 It is characterised by the immune system attacking the body’s tissues when gluten is ingested. 1This causes a range of symptoms including those affecting the gastrointestinal tract, tiredness, skin rash, subfertility, and neurological problems. 1Having Coeliac Disease myself, I have noted that adapting to a lifelong gluten free diet causes restrictions to eating habits, leading me to query if this could contribute to the development of an eating disorder, particularly Avoidance Restrictive Food Intake Disorder (ARFID). ARFID involves restricting the amount of food eaten or avoiding certain foods.2 To conduct my research, I used a range of secondary data, such as journals, studies, and the Coeliac UK charity.A study conducted on 137 Coeliac patients found that 57% had a suspected ARFID, shown by a survey measuring food and social burden on impact of a gluten free diet.3 The survey showed the main reason for restrictive eating was fear of gastrointestinal (GI) discomfort including IBS with 48% reporting this. 3As a main symptom of Coeliac Disease is GI discomfort this suggests that the fear of this causes patients to abnormally change eating habits, which can be characterised at ARFID. It is also important to consider the social factors Coeliac’s face which can cause restricted eating. A Quality of life (QOL) survey carried out on 538 Coeliac’s found that the social domain of life is negatively impacted, in particular dining out, with 81% of individuals noting they no longer do this.4These results suggest that the gluten free diet can cause an ARFID, and as a result further support needs to be offered to patients, particularly at the beginning of their diagnosis. By pursuing strict dietary control Coeliac’s are at risk of developing unhealthy habits, such as avoiding eating outside the home, or eating less to avoid associated symptoms. Therefore, gastroenterologists should consider offering psychological support to Coeliac’s in their annual appointments, and consider not only physical health, but mental health also.References National Health Service. Coeliac Disease. [Internet]. 2023 [cited 2023 Nov 1]; [1]. Available from: https://www.nhs.uk/conditions/coeliac-disease/Beat Eating Disorders. ARFID. [Internet]. 2019 [cited 2023 Nov 6]; [1]. Available from: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/arfid/Bennett A, Bery A, Espsito P. Avoidant/restrictive food intake disorder characteristics and prevalence in adult celiac disease patients. Gastro Help Advances [Internet.] 2022 [cited 2023 Nov 6];1(3):321–327. Available from: https://www.sciencedirect.com/science/article/pii/S2772572322000036Lee AR, Lebwohl B, Lebovits J. Factors associated with maladaptive eating behaviours, social anxiety, and quality of life in adults with celiac disease. Nutrients. [Internet]. 2021 [cited 2023 Nov 6];13(12):4494. Available from: https://www.mdpi.com/2072-6643/13/12/4494#B22-nutrients-13-04494