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US Autism & Asperger Association, Inc. January 5, 2009

Special Report: Evaluation, Diagnosis, and Treatment of Gastrointestinal
Disorders in Individuals With ASDs: A Consensus Report


Evaluation, Diagnosis, and Treatment of Gastrointestinal
Disorders in Individuals With ASDs: A Consensus Report

Timothy Buie, Daniel B. Campbell, George J. Fuchs, III, Glenn T. Furuta, JosephLevy, Judy VandeWater, Agnes H. Whitaker, Dan Atkins, Margaret L. Bauman, Arthur L. Beaudet, Edward G. Carr, Michael D. Gershon, Susan L. Hyman, PipopJirapinyo, Harumi Jyonouchi, Koorosh Kooros, Rafail Kushak, Pat Levitt, Susan E. Levy, Jeffery D. Lewis, Katherine F. Murray, Marvin R. Natowicz, Aderbal Sabra,Barry K. Wershil, Sharon C. Weston, Lonnie Zeltzer and Harland Winter Pediatrics 2010;125;S1-S18 DOI: 10.1542/peds.2009-1878C

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Abstract

Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.

Recognition that problem
behaviors might indicate an
underlying medical condition will facilitate
diagnosis and treatment and ultimately
improve the quality of life for
many persons with ASDs.

Autism spectrum disorders (ASDs) are a group of developmental disorders characterized by impairments in social interaction; varying degrees of verbal and nonverbal communication deficits; and restricted, repetitive, and stereotyped patterns of behavior and interests. The term includes autistic disorder, Asperger disorder, and pervasive developmental disorder, not otherwise specified (PDD-NOS).1 Approximately 1 of every 150 children in the United States has an ASD.2 In these children, a variety of gastrointestinal dysfunctions and associated symptoms have been reported frequently.

      Key Take Away Messages
  • Individuals with ASDs whose families report gastrointestinal symptoms warrant a thorough gastrointestinal evaluation.
  • All of the common gastrointestinal conditions encountered by individuals with typical neurologic development are also present in individuals with ASDs.
  • The communication impairments characteristic of ASDs may lead to unusual presentations of gastrointestinal disorders, including sleep disturbances and problem behaviors.
  • Caregivers and health care professionals should be alert to the presentation of atypical signs of common gastrointestinal disorders in patients with ASDs.
  • If a person with an ASD is on a restricted diet, professional supervision can help to identify and treat nutritional inadequacy.
  • Integrating behavioral and biomedical approaches can be advantageous in conceptualizing the role of pain as a setting event for problem behavior, facilitating diagnosis, and addressing residual pain symptoms to enhance quality of life.
  • Genetic assays should be included as part of the data to be collected in research protocols.
  • At present, there are inadequate data to establish a causal role for intestinal inflammation, increased intestinal permeability, immunologic abnormalities, or food allergies in ASDs.

In Statement 11 - Many dietary modifications are believed to have a beneficial outcome.

Statement 13 - For patients with ASDs, a detailed history should be obtained to identify potential associations between allergen exposure and gastrointestinal and/or behavioral symptoms.

In Statement 18 - These studies suggest an underlying chronic inflammatory process in some individuals with ASDs and co-occurring gastrointestinal disturbances, characterized by NLH [Nodular lymphoid hyperplasia], enterocolitis, and mucosal infiltration by immune cells along the length of the gastrointestinal tract.

Statement 21 - Studies of gastrointestinal disorders in ASDs should include genetic testing for all participants.

Click here for entire report in a PDF file from the American Academy of Pediatrics.

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/125/Supplement_1/S1


 

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