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Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis
Barbara O McElhanon1, Courtney McCracken1, Saul Karpen1
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and.
Insights
Children with autism spectrum disorder (ASD) experience significantly more gastrointestinal (GI) symptoms, including diarrhea and constipation, compared to neurotypical children. Further research is needed to understand the causes and impact of these GI issues in ASD.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Disorders
- Autism Spectrum Disorder Research
Background:
- Parental concerns regarding gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD) are common.
- The specificity and prevalence of these GI symptoms in ASD populations require further investigation.
Purpose of the Study:
- To conduct a comprehensive meta-analysis of existing research on GI symptoms in children diagnosed with ASD.
- To quantify the association between ASD and the occurrence of various GI symptoms.
Main Methods:
- Systematic literature search of Medline, PsycINFO, and PubMed databases (1980-2012).
- Inclusion of peer-reviewed studies with a comparison group and quantitative data on GI symptoms in ASD.
- Random-effects model used to calculate effect sizes and 95% confidence intervals (CIs).
Main Results:
- Children with ASD showed significantly higher rates of general GI symptoms (SMD=0.82, OR=4.42).
- Elevated odds ratios were observed for diarrhea (OR=3.63), constipation (OR=3.86), and abdominal pain (OR=2.45).
Conclusions:
- The meta-analysis confirms a greater prevalence of GI symptoms in children with ASD compared to controls.
- Methodological variability and limited data on GI pathophysiology hinder understanding of underlying causes.
- Future research should focus on standardized assessments and exploring potential moderators like dietary restrictions to elucidate GI symptom underpinnings in ASD.
Background:
In pediatric settings, parents often raise concerns about possible gastrointestinal (GI) symptoms in autism spectrum disorder (ASD), yet the specificity of these concerns are not well studied.
Objective:
To conduct a meta-analysis of research investigating GI symptoms among children with ASD.
Methods:
We searched Medline, PsycINFO, and PubMed databases (1980-2012) in peer-reviewed journals. Analysis involved studies with a comparison group presenting quantitative data on GI symptoms using combinations of terms for ASD and GI indicators. The systematic search yielded 15 studies. We calculated effect sizes and 95% confidence intervals (CIs) using a random-effects model.
Results:
Children with ASD experience significantly more general GI symptoms than comparison groups, with a standardized mean difference of 0.82 (0.24) and a corresponding odds ratio (OR) of 4.42 (95% CI, 1.90-10.28). Analysis also indicated higher rates of diarrhea (OR, 3.63; 95% CI, 1.82-7.23), constipation (OR, 3.86; 95% CI, 2.23-6.71), and abdominal pain (OR, 2.45; 95% CI, 1.19-5.07).
Conclusions:
Results indicate greater prevalence of GI symptoms among children with ASD compared with control children. Identified studies involved high methodological variability and lack of comprehensive data prohibited analysis of GI pathophysiologies (eg, gastroesophageal reflux) typically associated with organic etiologies, limiting conclusions about the underpinnings of the observed association. Future research must address critical questions about the causes and long-term impact of GI symptoms in ASD. Such analyses will require more systematic research and clinical activities, including improved diagnostic screening, standardized assessment, and exploration of potential moderators (eg, dietary restrictions).
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