Interoception in Practice: The Gut-Brain Connection.

Area of Science:

• Pediatrics
• Gastroenterology
• Child Psychiatry

Background:

• A five-and-a-half-year-old boy with a history of autism spectrum disorder (ASD), ADHD, anxiety, and insomnia presented with acute emesis and refusal to eat or drink.
• The patient had a complex birth history including prematurity, prenatal exposure to substances, and inadequate prenatal care, with early childhood diagnoses of kidney reflux, failure to thrive, and developmental delays.

Observation:

• The child exhibited significant behavioral challenges from age 3, including destructive rages, hyperactivity, impulsivity, self-injurious behaviors, and restrictive eating habits.
• Despite developmental progress and positive response to psychotropic medications, he experienced sudden behavioral worsening at age five and a half, preceding his current gastrointestinal symptoms.

Findings:

• A comprehensive medical workup, including upper endoscopy and biopsy, led to a diagnosis of eosinophilic esophagitis (EoE).
• The patient presented with dehydration due to two weeks of persistent vomiting and refusal to consume food or liquids.

Implications:

• The case highlights the importance of considering gastrointestinal conditions like EoE in children with neurodevelopmental disorders presenting with unexplained behavioral changes and feeding issues.
• Further investigation is warranted to understand the interplay between EoE and the patient's existing behavioral and psychiatric diagnoses.
• Management strategies should address both the gastrointestinal and behavioral aspects of the patient's condition.