Gastroenterology

Gastrointestinal (GI) disturbances are among the most frequent comorbidities associated with autism spectrum disorder (ASD). The extent to which GI issues are causally related to autism or are strictly comorbid conditions of ASD remains to be defined. Clinical and research experience indicates an important role for GI conditions in autism and their impact on children with ASD and their families. While the reported prevalence of GI symptoms among children with ASD varies widely, consensus exists that GI problems including constipation, diarrhea, and abdominal pain are frequent and manifest in common as well as unusual symptoms compared to symptoms in neurotypical children. The microbiome-gut-brain axis in children with ASD is an emerging area of interest and research, although the exact mechanisms and clinical implications in the context of ASD remain to be defined. Intestinal microbial dysbiosis is currently being evaluated in children with ASD yielding conflicting results. Some studies have shown improvement in behavior and decreased severity of GI symptoms in children with ASD with the use of prebiotics, probiotics, and other dietary interventions. Studies using rigorous methodology to better characterize GI pathophysiology and repercussions in children with ASD can be expected to result in more effective interventions. Effective management of specific GI issues and potential underlying causes is often best achieved through a multidisciplinary, coordinated approach in which the primary care provider or gastroenterologist interacts closely with other disciplines such as psychology, neurology, dietetics, child development, and social work. It is important for the clinic environment to be welcoming and supportive, with individualized accommodations made as needed.