跨胃肠道的回避/限制性食物摄入
Avoidant/restrictive food intake across the gastrointestinal tract.
文献信息
| PMID | 42854770 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Karen Routhiaux |
| 作者单位 | Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KULeuven, Belgium. |
| 期刊 | Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association |
| SCI 分区 | Q1 |
| IF | 13.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 回避/限制性食物摄入障碍（ARFID）的特征是饮食摄入减少导致医学和/或心理社会损害，且与体像担忧无关。我们旨在评估胃肠道疾病患者与健康志愿者（HV）中的ARFID筛查和特征，及其与症状严重程度、肠外症状和抑郁评分的关联。
方法： 我们分析了92名HV和来自七个三级队列的467名患者：肠易激综合征（IBS，n=88）、功能性消化不良（FD，n=83）、便秘（n=59）、反流（n=107）、癔球症（n=45）、吞咽困难（n=37）和贲门失弛缓症（n=48），分为非食管性疾病（IBS、FD、便秘）和食管性疾病（反流、癔球症、吞咽困难和贲门失弛缓症）。评估包括罗马IV标准、肠外症状和抑郁评分（PHQ-12/9）以及ARFID筛查。ARFID+定义为NIAS+（≥1个分量表 cutoff：挑食≥10，食欲≥9，恐惧≥10）加上DSM-5损害。比值比来自多重逻辑回归，采用三级分层方法，调整症状严重程度、肠外和抑郁症状。
结果： 与HV相比，IBS（OR=15.0）、FD（OR=10.6）、便秘（OR=18.2）、反流（OR=5.2）和吞咽困难（OR=7.0）与ARFID+相关，而癔球症或贲门失弛缓症则不相关。非食管性疾病中ARFID+的患病率高于食管性疾病（24% vs. 11%；OR=2.7，p<0.001），调整后仍显著。在非食管性疾病中，抑郁症状（OR=1.1）和食物相关腹痛（OR=1.2）与ARFID+独立相关，基于恐惧的食物回避成为疼痛相关限制性进食的主要贡献因素（β=0.3，p<0.001）。
结论： ARFID症状在非食管性疾病中比食管性疾病更普遍。在非食管性疾病中，症状严重程度和食物相关腹痛与ARFID+相关，且主要以对厌恶后果的恐惧为特征。
英文摘要
BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) is characterized by reduced dietary intake leading to medical and/or psychosocial impairment, independent of body image concerns. We aim to assess ARFID screening and characteristics in patients with gastrointestinal disorders versus healthy volunteers (HV), and its associations with symptom severity, extraintestinal symptoms and depression scores.
METHODS: We analyzed 92 HV and 467 patients from seven tertiary cohorts: irritable bowel syndrome (IBS, n=88), functional dyspepsia (FD, n=83), constipation (n=59), reflux (n=107), globus (n=45), dysphagia (n=37), and achalasia (n=48), grouped into non-esophageal (IBS, FD, constipation) and esophageal disorders (reflux, globus, dysphagia and achalasia). Assessments included Rome IV criteria, extraintestinal symptoms and depression scores (PHQ-12/9), and ARFID screening. ARFID+ was defined as NIAS+ (≥1 subscale cutoff: picky eating ≥10, appetite ≥9, fear ≥10) plus DSM-5 impairment. Odds ratios were derived from multiple logistic regression with three-level hierarchical approach adjusted for symptom severity, extra-intestinal, and depression symptoms.
RESULTS: Compared to HV, IBS (OR=15.0), FD (OR=10.6), constipation (OR=18.2), reflux (OR=5.2) and dysphagia (OR=7.0) were associated with ARFID+, whereas globus or achalasia were not. A higher prevalence of ARFID+ was observed in non-esophageal versus esophageal disorders (24% vs. 11%; OR=2.7, p<0.001), remaining significant after adjustments. Within non-esophageal disorders, depressive symptoms (OR=1.1) and food-related abdominal pain (OR=1.2) were independently associated with ARFID+, with fear-based food avoidance emerging as primary contributor to pain-related restrictive eating (β=0.3, p<0.001).
CONCLUSION: ARFID symptoms are more prevalent across non-esophageal disorders compared to esophageal disorders. Within non-esophageal disorders, symptoms severity and food-related abdominal pain are associated with ARFID+, and mostly characterized by fear of aversive consequences.