Prevalence and Clinical Correlates of Avoidant/Restrictive Food Intake Disorder (ARFID) Among Patients with Inflammatory Bowel Disease: A Systematic Review

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by inadequate or restricted food intake unrelated to body image or weight concerns. ARFID is frequently observed in patients with gastrointestinal disorders. Given the growing clinical interest, we conducted this systematic review to synthesize evidence, assessment approaches regarding ARFID-like symptomatology in adult patients with inflammatory bowel disease (IBD). A systematic search of MEDLINE, Scopus, Web of Science, PsycInfo was conducted in July 2025, yielding seven studies on ARFID in IBD. This review followed the framework outlined by Page (2021). Prevalence rates, assessment tools, associations with clinical, psychological factors were synthesized. Reported prevalence of ARFID-like behaviors ranged from 10.2 to 51.3%, reflecting differences in screening tools, cut-offs. Studies applying lower cut-offs (≥ 24) for the Nine Item ARFID Screen (NIAS) showed a weighted mean prevalence of 24, 2%, whereas stricter cut-offs (≥ 28) resulted in a a prevalence of 18, 6%, in line with the results from the Pica, ARFID, Rumination Disorder Interview–ARFID Questionnaire (PARDI-AR-Q). Higher ARFID levels were consistently linked to symptom-based clinical activity. Despite limited evidence, in some patients with normalized inflammatory markers, restrictive eating may persist, suggesting functional mechanisms beyond inflammation. Psychological distress, particularly anxiety, gastrointestinal-specific anxiety, was strongly associated with ARFID-like behaviors. The interplay between ARFID, symptom activity, psychological distress underscores the need for an integrated approach addressing gastroenterological, psychological, nutritional factors, aiming to improve ARFID screening, management in patients with IBD