Gastrointestinal symptoms common in autism spectrum disorder

By Will Boggs MD

NEW YORK (Reuters Health) - Individuals with autism spectrum disorder (ASD) are more than four times as likely as other individuals to experience gastrointestinal (GI) symptoms, according to a meta-analysis.

"We hope that this report raises awareness about the need to evaluate GI symptoms during routine healthcare screenings in ASD, especially if a child presents with unexplained behavior change," Dr. William G. Sharp from Emory University School of Medicine, Atlanta, Georgia, told Reuters Health by email.

"In addition, we suggest practitioners adopt a lower threshold for referring for evaluation and treatment by a gastroenterologist if an underlying problem is suspected."

Although GI dysfunction and feeding problems are common in ASD, the authors say some earlier reports have suffered from a lack of rigor in defining and characterizing these problems.

Dr. Sharp and colleagues sought to clarify these issues by undertaking a meta-analysis of 15 articles that addressed GI symptoms among 2,215 individuals with ASD. The studies used caregiver reports (73%) or medical chart reviews (27%).

Overall, the prevalence of GI symptoms was 4.42-fold higher among children with vs without ASD, they reported online April 28 in Pediatrics.

Compared with typically developing children, children with ASD had 3.63 times the prevalence of diarrhea, 3.86 times the prevalence of constipation, and 2.45 times the prevalence of abdominal pain.

"Our systematic search for evidenced-based research focusing on GI symptoms in ASD yielded only 15 studies published over a 32-year period," Dr. Sharp said. "This highlights a clear need for research investigating the GI system, ideally with consideration to the high prevalence of feeding problems and related behavioral issues (e.g., toileting concerns) documented in this population."

"Children with ASD are known to experience high rates of feeding problems," Dr. Sharp said. "These concerns most often involve strong preferences for fats, snacks, and processed food, and rejection of fruits and vegetables. This pattern of food selectivity may lead to or make worse GI symptoms, such as abdominal pain or constipation."

"We recommend that questions regarding feeding behaviors and nutrition intake be part of routine healthcare screening," Dr. Sharp added. "If concerns exist, families should be referred for evaluation and treatment, preferably to a multidisciplinary team with expertise in the management of mealtime concerns in ASD."

Dr. Sue X. Ming from Rutgers University-New Jersey Medical School in Newark told Reuters Health by email, "GI disorders could be a big piece of the puzzle in the pathogenesis of many of the symptoms or comorbidities of ASD that deserves special attention in autism research."

"GI symptoms, diarrhea or constipation could lead to malabsorption of essential nutrients, and imbalance of gut microbiome in some of the patients could potentially lead to systemic nutritional disturbances which in turn lead to cellular dysfunction," Dr. Ming explained.

Given the communication/sensory issues that go along with ASD, "more time should be allocated for history taking and discussion/planning of treatment options/pathways," Dr. Manya Angley from the University of South Australia, Adelaide, Australia, told Reuters Health by email. "Prebiotics are potentially of benefit given they can produce a favorable GI microbiota profile and don't cause harm."

"Improving GI symptoms may improve behavior and quality of life of patients with ASD," Dr. Angley said. "It is not clear if GI problems play a role in etiology or are a consequence of ASD."

SOURCE: http://bit.ly/1km2NNG

Pediatrics 2014;133:872-883.

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