Gastrointestinal Conditions in Children With Autism Spectrum Disorder: Developing a Research Agenda

Abstract

Autism spectrum disorders (ASDs) are a set of complex neurodevelopmental disorders defined behaviorally by impaired social interaction, delayed and disordered language, repetitive or stereotypic behavior, and a restricted range of interests. ASDs represent a significant public health issue with recent estimates indicating that as many as 1% of children in the United States are diagnosed with an ASD. 1,2 Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal (GI) disorders, which have significant health, developmental, social, and educational impacts. Gastrointestinal complaints are a commonly reported concern for parents and may be related to problem behaviors and other medical issues such as dysregulated sleep (ATN Annual Registry Report, unpublished data, November 2009). 3 Despite the magnitude of these issues, potential GI problems are not routinely considered in ASD evaluations. This likely reflects several factors, including variability in reported rates of GI disorders, controversies regarding the relationship between GI symptoms and the putative causes of autism, the limited verbal capacity of many ASD patients, and the lack of recognition by clinicians that certain behavioral manifestations in children with ASDs are indicators of GI problems (eg, pain, discomfort, or nausea). [4][5][6][7][8][9][10] Whether GI issues in this population are directly related to the pathophysiology of autism, or are strictly a comorbid condition of ASD remains to be determined, but clinical practice and research to date indicate the important role of GI conditions in ASDs and their impact on children as well as their parents and clinicians. 9 On November 15, 2009, a symposium addressing these issues was organized as an adjunct to the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. A panel of international experts presented the latest scientific information on pathophysiology, evaluation, and treatment strategies for GI conditions in children and adolescents with ASDs. One aim of the meeting was to raise awareness among gastroenterologists and GI researchers of GI disorders in the ASD population and to provide clinicians with information to improve their clinical practice for these children. The symposium addressed 4 major areas of concern for children with ASDs: reflux, constipation, diarrhea, and nutrition. Each session reviewed the state of the evidence, the latest findings on issues such as intestinal permeability, inflammatory processes, innervation, motility, nutrition, and the epidemiology, presentation, and clinical management of GI issues.The symposium also set the context for a follow-up workshop on November 16 that focused on identifying and prioritizing the key research topics for further investigation. The 1-day workshop brought together AUTHORS:

Modulatory Effects of Gut Microbiota on the Central Nervous System: How Gut Could Play a Role in Neuropsychiatric Health and Diseases

“…144 A few small clinical trials have shown beneficial effects for gluten free and casein free diets on symptoms of children with ASD 145,146 that could potentially be attributed to the change in gut microbiota. 4,8,19,61,128,147 Furthermore, in children with autism, the frequency of GI symptoms is increased 148,149 and has been attributed to a low-grade chronic inflammation in the GI tract caused by altered gut microbiota. In a clinical study, oral vancomycin was used as a minimally absorbed antibiotic to treat the GI problems, based on this theory.…”

The Role of Intestinal Dysbiosis in the Pathogenesis of Autism: Minireview

“…In any case the high prevalence of the GI manifestations [16,17] highlight the possibility that they might may be linked to gut dysbiosis.…”

Envolvimento Da Flora Intestinal Na Modulação De Doenças Psiquiátricas

“…Embora o autismo seja uma doença multifatorial, distúrbios no trato GI estão associados à prevalência e severidade de sintomas da doença (95,96). Por exemplo, estudos com o objetivo de investigar o trato GI de pacientes autistas encontraram anormalidades na motilidade gástrica e aumento da permeabilidade intestinal, além de alterações na composição da flora (97,98).…”