P055  Restrictive Eating Symptoms May Persist in Children & Adolescents with Treated IBD: Case series

P055  Restrictive Eating Symptoms May Persist in Children & Adolescents with Treated IBD: Case series

 

Schouten Jonathan1, Wahbeh Ghassan1
1 Seattle Children's Hospital, Seattle, United States

BACKGROUND: Symptoms of IBD can overlap with patterns of restrictive eating disorders in children and adolescents. In addition to medical treatments, exclusionary diets are gaining interest in IBD management. IBD patients may have a complex psychosocial relationship with food due to their disease and psychosocial challenges during adolescence. Moreover, diet exclusionary treatment modalities may contribute to the risk of developing restrictive eating behaviors in an already vulnerable population. Few studies have described a possible association between IBD and Eating Disorders (ED). We describe a case series of pediatric IBD patients with restrictive eating behaviors.

METHODS: Patients ≤ 18 years old were identified through search by ICD codes for IBD & ED at Seattle Children’s Hospital, University of Washington. Additionally, we queried the IBD team’s physicians, nurses, dieticians and psychologist to identify patients seen in our outpatient clinic with suspected ED. Symptoms of ED were determined based on the criteria set forth by the DSM-V. Patients selected exhibited at least one of the diagnostic criteria for Avoidant/Restrictive Food Intake Disorder or Eating Disorders Not Otherwise Specified (ED-NOS). Patients included if they had ED symptoms in >2 clinic visits with their care teams. Retrospective medical record review was done for clinical presentation, IBD course and treatment including dietary therapy, mental health disorder history and outcome as of last follow up.

RESULTS:  Ten patients were identified with IBD and restrictive eating patterns. Age at diagnosis was 7-16 years, 8 females and 2 males. 7 had CD, 2 UC, and 1 IBDU. Five patients had known mental health conditions at time of IBD diagnosis (anxiety, ADHD, Major Depressive Disorder). 2/10 patients had formal ED diagnosis before their IBD diagnosis. 8/10 patients developed symptoms of ED after IBD diagnosis and met criteria for ED NOS. 6/8 (75%) patients with ED NOS after IBD diagnosis were exposed to diet therapy: 2 EEN, 4 EEN with subsequent SCD. 3/6 had a prior mental health diagnosis. ED NOS appeared within a median of 22 months from diet therapy initiation (range 2 months-3 years). Of the 2 patients with a previous ED diagnosis, 1 was exposed to diet therapy. Both patients had persistent ED symptoms despite remission with biologic therapy. Of the 6 patients with ED NOS after IBD diagnosis who were exposed to diet therapy, 4 had persistent ED despite clinical remission with biologic therapy. Lastly, both patients who developed ED NOS after IBD diagnosis and were not exposed to diet therapy had persistent ED NOS symptomatology despite remission with biologics.

CONCLUSION: 8/10 children with IBD and ED disorder symptoms diagnosed before or after IBD diagnosis had persistent ED symptoms despite successful IBD therapy with biologics. The overlap between IBD and ED merits further study to outline the incidence of ED in IBD, possible risk factors for persistent ED and understand patient outcomes. In our case series, ED symptoms persisted in patients regardless of whether nutrition therapy was used or not.