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Gut mobilization improves behavioral symptoms and modulates urinary p-cresol in chronically constipated autistic
Laura Turriziani1, Arianna Ricciardello1, Francesca Cucinotta1,2
1Interdepartmental Program "Autism 0-90", "G. Martino" University Hospital of Messina, Messina, Italy.
Insights
Improving gut motility in autistic children with constipation significantly reduced behavioral symptoms like hyperactivity and anxiety. This intervention offers a simple strategy to manage autism spectrum disorder (ASD) comorbidities.
Area of Science:
- Neuroscience
- Gastroenterology
- Developmental Pediatrics
Background:
- Chronic constipation is prevalent in children with autism spectrum disorder (ASD).
- Constipation in ASD is linked to increased hyperactivity, anxiety, and repetitive behaviors.
- Elevated urinary p-cresol, a gut bacteria byproduct, is observed in constipated autistic children and affects brain function.
Purpose of the Study:
- To prospectively evaluate the behavioral impact of gut mobilization in young autistic children with chronic constipation.
- To investigate the correlation between behavioral changes and urinary p-cresol levels post-intervention.
Main Methods:
- 21 autistic children (2-8 years) with chronic constipation were assessed.
- Evaluations included Bristol stool scale, urinary p-cresol concentration, and behavioral scores (social deficits, stereotypy, anxiety, hyperactivity) at baseline, 1 month, and 6 months post-intervention.
- Intervention involved intestinal mobilization.
Main Results:
- Gut mobilization led to a significant, progressive decrease in all assessed behavioral symptoms over 6 months.
- Urinary p-cresol levels showed variable trends, increasing at 1 month and decreasing at 6 months, with no significant correlation to behavioral changes.
- No significant correlation was found between urinary p-cresol levels and behavioral improvements.
Conclusions:
- Gut mobilization is a viable strategy for improving ASD symptoms, including anxiety and hyperactivity, in constipated children.
- Reduced abdominal discomfort may play a larger role in behavioral improvements than changes in p-cresol levels.
- Further research is needed to clarify the roles of microbiome modifications and gut bacteria-derived neuroactive compounds.
Abstract:
Chronic constipation is common among children with ASD and is associated with more severe hyperactivity, anxiety, irritability, and repetitive behaviors. Young autistic children with chronic constipation display higher urinary, and foecal concentrations of p-cresol, an aromatic compound produced by gut bacteria, known to negatively affect brain function. Acute p-cresol administration to BTBR mice enhances anxiety, hyperactivity and stereotypic behaviors, while blunting social interaction. This study was undertaken to prospectively assess the behavioral effects of gut mobilization in young autistic children with chronic constipation, and to verify their possible correlation with urinary p-cresol. To this aim, 21 chronically constipated autistic children 2-8 years old were evaluated before (T0), 1 month (T1), and 6 months (T2) after intestinal mobilization, recording Bristol stool scale scores, urinary p-cresol concentrations, and behavioral scores for social interaction deficits, stereotypic behaviors, anxiety, and hyperactivity. Gut mobilization yielded a progressive and highly significant decrease in all behavioral symptoms over the 6-month study period. Urinary p-cresol levels displayed variable trends not significantly correlated with changes in behavioral parameters, mainly increasing at T1 and decreasing at T2. These results support gut mobilization as a simple strategy to ameliorate ASD symptoms, as well as comorbid anxiety and hyperactivity, in chronically constipated children. Variation in p-cresol absorption seemingly provides limited contributions, if any, to these behavioral changes. Further research will be needed to address the relative role of reduced abdominal discomfort following mobilization, as compared to specific modifications in microbiome composition and in gut bacteria-derived neuroactive compounds.
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