BACKGROUND
Avoidant/restrictive food intake disorder (ARFID) can be difficult to distinguish from food avoidance that is an adaptive response to gastrointestinal disease. ARFID-like restrictive eating is relatively common in patients with inflammatory bowel disease (IBD), whereas the frequency of undiagnosed IBD among patients initially diagnosed with ARFID remains unclear. We report the case of a young woman who was admitted with presumed ARFID and was subsequently diagnosed with ileocolonic Crohn’s disease.
CASE REPORT
A 19-year-old Japanese woman was admitted to a psychiatric ward with severe emaciation (body mass index, 10.96 kg/m²), fear of eating because of postprandial abdominal pain and nausea, and no weight- or shape-related psychopathology. ARFID was initially suspected. However, the diagnosis was reassessed because of persistent diarrhea, fluctuating C-reactive protein elevation, anemia, and poor response to nutritional rehabilitation. Contrast-enhanced computed tomography and gastrointestinal endoscopy revealed ileocolonic Crohn’s disease. After transfer to the gastroenterology department, nutritional therapy and risankizumab were initiated. The intestinal inflammation improved, the eating difficulty resolved, and psychiatric treatment was discontinued. She remained psychiatrically stable without recurrence of eating difficulty during 1 year of follow-up.
CONCLUSIONS
Crohn’s disease can present with ARFID-like food restriction rather than persistent primary ARFID when food restriction is driven by postprandial abdominal pain, nausea, and diarrhea. Longitudinal reassessment for IBD should be considered when gastrointestinal symptoms, inflammatory markers, anemia, or poor response to refeeding persist.

Keywords: Avoidant Restrictive Food Intake Disorder; Crohn Disease; Inflammatory Bowel Diseases