Elsevier

The Journal of Pediatrics

Volume 135, Issue 5, November 1999, Pages 559-563
The Journal of Pediatrics

Gastrointestinal abnormalities in children with autistic disorder,☆☆,

https://doi.org/10.1016/S0022-3476(99)70052-1Get rights and content

Abstract

Objectives: Our aim was to evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastrointestinal symptoms. Study design: Thirty-six children (age: 5.7 ± 2 years, mean ± SD) with autistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. The most frequent gastrointestinal complaints were chronic diarrhea, gaseousness, and abdominal discomfort and distension. Results: Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duodenitis in 24. The number of Paneth’s cells in the duodenal crypts was significantly elevated in autistic children compared with non-autistic control subjects. Low intestinal carbohydrate digestive enzyme activity was reported in 21 children (58.3%), although there was no abnormality found in pancreatic function. Seventy-five percent of the autistic children (27/36) had an increased pancreatico-biliary fluid output after intravenous secretin administration. Nineteen of the 21 patients with diarrhea had significantly higher fluid output than those without diarrhea. Conclusions: Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients. The observed increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver. Further studies are required to determine the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder. (J Pediatr 1999;135:559-63)

Section snippets

PATIENTS AND METHODS

Children diagnosed with autistic disorder or pervasive developmental disorder, not otherwise specified by professionals with expertise in behavioral pediatrics were referred to our gastroenterology clinic for further evaluation.

Thirty-six children with one or more of the following symptoms including abdominal pain (n = 25), chronic diarrhea (n = 21), gaseousness/bloating (n = 21), nighttime awakening (n = 15), and unexplained irritability (n = 18) underwent esophagogastroduodenoscopy. The mean

Histologic Findings

The most frequent histologic finding was the presence of reflux esophagitis in 25 of 36 children (69.4%). Twenty-two of these 25 children (88%) had symptoms such as nighttime awakening with irritability, signs of abdominal discomfort, or pushing on the abdomen, which are typically reported by non-autistic children with esophagitis. Chronic inflammation of the gastric mucosa was present in 15 children. None of the patients had H pylori infection. Chronic nonspecific duodenal inflammation was

DISCUSSION

Few studies have addressed gastrointestinal problems in children with autistic disorder. Goodwin et al7 studied 15 randomly selected children with autism and found that 6 had either bulky, odorous, or loose stools or intermittent diarrhea; one had celiac disease. In a recent study, 43% of the autistic patients without symptoms or evidence of any gastrointestinal disease had altered intestinal permeability.2 Low concentrations of serum α1-antitrypsin were reported in children with typical autism,

Acknowledgements

We thank Lisa Medeiros, BSN, and Tina Sewell, BSN, for their help with patient recruitment and during the procedures; their contribution was important to accomplish this work. We are very grateful to Lois Roeder, PhD, for her contribution in the preparation of the manuscript.

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Supported by an intramural grant by the University of Maryland School of Medicine.

☆☆

Reprint requests: Karoly Horvath, MD, PhD, Department of Pediatrics, 22 S Greene St, N5W70, Box 140, Baltimore, MD 21201-1595.

0022-3476/99/$8.00 + 0  9/21/101636

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