A Clinical Practice Update for the Management of Patients With Disorders of Gut‐Brain Interaction and Altered Food Intake Behavior

BACKGROUND: Disorders of Gut-Brain Interaction (DGBI) impact as many as one in three individuals at some stage of their lives. Clinically, patients with DGBI may present with meal-related symptoms that progressively lead to altered food intake behaviors, resulting in subsequent weight loss and nutritional deficiencies. These patients often experience psychological distress and multi-system co-morbidities. This distinct subgroup can be referred to as DGBI-induced altered food intake behavior (DGBI-AFIB) and needs to be differentiated from the eating disorder defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition: Avoidant/Restrictive Food Intake Behavior. PURPOSE: There is currently no expert consensus on the management of DGBI-AFIB. To address this gap, a multidisciplinary, multi-society expert panel employed a Delphi process to develop evidence-based management guidelines for DGBI-AFIB. The group formulated and evaluated 23 statements using the GRADE system. Experts agreed that a diagnosis of DGBI-AFIB should be considered when gastrointestinal symptoms meet the Rome criteria for DGBI, are aggravated by food intake, and subsequently result in altered (reduced) food intake, leading to a significant (unintended) reduction in body weight. To establish a positive diagnosis of DGBI-AFIB, relevant differential diagnoses need consideration, including organic causes/eating disorders. A multidisciplinary team approach is key to management. Treatment must align with established DGBI principles and consider each patient's specific challenges. Enteral or parenteral feeding should only be pursued in patients with life-threatening nutritional deficiencies after all oral nutrition approaches have failed. Future research is essential to elucidate the epidemiological characteristics and risk factors for DGBI-AFIB, thereby enhancing long-term management.