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Gastrostomy tube placement for children with autism spectrum disorders and functional constipation
Shruthi Srinivas1,2, Ihab Halaweish1,2, Kristine L Griffin1,2
1Department of Pediatric Colorectal and Pelvic Reconstructive Surgery Nationwide Children's Hospital Columbus Ohio USA.
Insights
Gastrostomy tube (GT) placement can effectively treat functional constipation (FC) in children with autism spectrum disorder (ASD) who struggle with oral medications. This intervention improved bowel function and quality of life with minimal complications.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Disorders
- Surgical Interventions
Background:
- Children with autism spectrum disorder (ASD) and functional constipation (FC) often present with sensory and behavioral challenges.
- These challenges frequently impede the administration of oral medications essential for managing constipation and incontinence.
Purpose of the Study:
- To evaluate the efficacy and safety of gastrostomy tube (GT) placement in children diagnosed with both ASD and FC.
- To assess the impact of GT placement on constipation symptoms, medication administration, and quality of life in this specific pediatric population.
Main Methods:
- A retrospective review of nine children with ASD and FC who underwent GT placement between 2020 and 2023.
- Data collected included ASD severity, FC symptoms (stool consistency, straining), and quality of life scores before and after GT placement.
Main Results:
- Following GT placement, a significant improvement in stool consistency was observed (from Bristol 1-2 to Bristol 5-6 in most patients).
- Straining during bowel movements decreased substantially, and gastrointestinal quality of life scores improved for both constipation and medication administration.
- No instances of tube dislodgement or site infections were reported, indicating a favorable safety profile.
Conclusions:
- Gastrostomy tube placement presents a viable therapeutic option for children with ASD and FC who have difficulties with oral intake.
- GTs can lead to significant improvements in constipation, enhance medication delivery, and positively impact the overall quality of life for these children.
- Further prospective research is recommended to validate these findings and assess generalizability across broader patient cohorts.
Objectives:
Children with functional constipation (FC) and autism spectrum disorder (ASD) often face sensory and behavioral conditions that prevent giving oral medical therapy to improve constipation and incontinence. We aimed to assess whether children with ASD and FC who had difficulty in taking oral medications could benefit from gastrostomy tube (GT) placement.
Methods:
A single-institution retrospective review was performed in children diagnosed with ASD and FC from 2020 to 2023. Children were considered candidates for GT if they suffered from constipation that adversely affected daily function and refused adequate oral medical therapy. Data were collected on ASD severity and FC symptoms before GT and after GT placement.
Results:
There were nine patients who underwent GT placement. Median age was 7.4 years (interquartile range [IQR]: 4.8-9.7). Of the five with available ASD evaluations, four had extremely low intelligence quotient and extremely low adaptive skills; only one child of the nine was verbal. Before GT placement, most patients had Bristol 1 or 2 consistency stool (66.7%); following placement, most had Bristol 5 or 6 consistency stool (66.7%). Seven children strained with bowel movements before GT; only one child strained after GT. There were no tube dislodgements or site infections. Gastrointestinal quality of life scores improved for both constipation (+38.5, IQR: 27.5-54.3) and medication administration (+31.5, IQR: 0.0-75.0).
Conclusions:
GT placement may be a viable option in children with FC and ASD with minimal complications, improvement in constipation, and improvement in quality of life. Further prospective study will ensure generalizability of these results.
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