Management of severe or refractory FD
We recommend a multidisciplinary support team should be involved for patients with severe or refractory FD (recommendation: strong, quality of evidence: low).

We recommend opioids and surgery should be avoided in patients with severe or refractory FD to minimise iatrogenic harm (recommendation: strong, quality of evidence: very low).

We recommend patients with severe or refractory FD presenting with weight loss and food restriction are assessed for eating disorders and disordered eating, including avoidant restrictive food intake disorder (ARFID) (recommendation: strong, quality of evidence: very low).

We recommend early dietitian involvement in patients with severe or refractory FD to avoid an overly restrictive diet (recommendation: strong, quality of evidence: very low).

G Mohan.