Abstract
BACKGROUND AND AIMS: Disentangling whether disordered eating is a cause, consequence or manifestation of inflammatory bowel disease (IBD) symptoms remains a challenge. We conducted an updated systematic review and the first meta-analysis to estimate the prevalence of eating disorders in individuals with IBD. METHODS: We systematically searched MEDLINE, Embase and PsycINFO from inception to 28 October 2025, for original observational studies reporting the prevalence of at least one eating disorder in an IBD population. Pooled prevalence estimates were calculated using random-effects models and stratified by IBD type, sex, age and assessment method. Between-study heterogeneity was assessed using Q and I(2) statistics. RESULTS: Twenty-three studies were included. Prevalence estimates varied substantially depending on how eating disorders were assessed. Studies using self-report questionnaires yielded a pooled prevalence of 13.60% (95% CI = 9.86%-17.81%; I(2) = 90.7%; n = 18), whereas studies employing physician-assigned diagnoses yielded a lower pooled prevalence of 2.84% (95% CI = 0.00%-9.03%; I(2) = 99.9%; n = 5). The highest prevalence was observed in studies using the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen, with a pooled estimate of 17.10% (95% CI = 12.81%-21.88%; I(2) = 87.4%; n = 9). No significant differences in prevalence were found by sex, IBD subtype, age at time of study or disease activity. CONCLUSIONS: Eating disorders are prevalent among individuals with IBD, particularly avoidant/restrictive types. These findings highlight the need for improved screening and greater clinical awareness to better detect and manage disordered eating in the IBD population.