Cited by 298Child Nutrition and Feeding IssuesAutism Spectrum Disorder ResearchGastrointestinal motility and disorders

Incidence of Gastrointestinal Symptoms in Children With Autism: A Population-Based Study

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Ibrahim, Samar H., Voigt, Robert G., Katusic, Slavica K., Weaver, Amy L., Barbaresi, William J.·2009·PEDIATRICS

Abstract

OBJECTIVE: To determine whether children with autism have an increased incidence of gastrointestinal symptoms compared with matched control subjects in a population-based sample. DESIGN/METHODS: In a previous study including all of the residents of Olmsted County, Minnesota, aged <21 years between 1976 and 1997, we identified 124 children who fulfilled criteria on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for a research diagnosis of autism. Two matched control subjects were identified for each case subject. Through the Rochester Epidemiology Project, all medical diagnoses, are indexed for computerized retrieval. Gastrointestinal diagnoses before 21 years of age were grouped into 5 categories: (1) constipation; (2) diarrhea; (3) abdominal bloating, discomfort, or irritability; (4) gastroesophageal reflux or vomiting; and (5) feeding issues or food selectivity. The cumulative incidence of each category was calculated by using the Kaplan-Meier method. Cox proportional hazards models were fit to estimate the risk ratios (case subjects versus control subjects) and corresponding 95% confidence intervals. RESULTS: Subjects were followed to median ages of 18.2 (case subjects) and 18.7 (control subjects) years. Significant differences between autism case and control subjects were identified in the cumulative incidence of constipation (33.9% vs 17.6%) and feeding issues/food selectivity (24.5% vs 16.1). No significant associations were found between autism case status and overall incidence of gastrointestinal symptoms or any other gastrointestinal symptom category. CONCLUSIONS: As constipation and feeding issues/food selectivity often have a behavioral etiology, data suggest that a neurobehavioral rather than a primary organic gastrointestinal etiology may account for the higher incidence of these gastrointestinal symptoms in children with autism.

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Crossref · 10.1542/peds.2008-2933

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  • A variety of GI issues commonly occur in ASD, including lower GI symptoms (constipation, diarrhea) and upper GI symptoms (nausea and vomiting, stomach aches and pains).

    “A variety of gastrointestinal (GI) issues commonly occur in ASD, including lower GI symptoms (i.e., constipation, diarrhea) and upper GI symptoms (i.e., nausea and vomiting, stomach aches and pains) (2–10), but the etiology is poorly understood.”
  • A 2009 longitudinal study up to 18 years did not report increased risk of GI diseases of inflammatory and/or malabsorption nature in ASD compared to typical development controls; the only significant difference was higher incidence of food selectivity and constipation in ASD.

    “However, a study conducted in 2009 on people with ASD followed longitudinally up to 18 years, did not report an increased risk of GI diseases of an inflammatory and/or malabsorption nature compared to the typical development controls; the only significant difference found was the higher incidence of food selectivity and constipation in ASD people [127].”
  • Food selectivity can exacerbate or determine GI symptoms such as constipation due to a diet rich in carbohydrates and poor in fiber that does not promote intestinal transit.

    “Moreover, food selectivity can exacerbate or determine GI symptoms (e.g., constipation) due to a diet rich in carbohydrates and poor in fiber that do not promote intestinal transit and can lead to constipation [127].”
  • The prevalence of gastrointestinal symptoms in ASD varies from 23% to 70%.

    “Although the connection between gastrointestinal problems and autism is still not resolved and the prevalence of gastrointestinal symptoms varies from 23 to 70% [31,125,126,127,128,129].”
  • The presence of GI disorders together with food selectivity could constitute a specific clinical phenotype characterized by frequent problematic behaviors such as anxiety, self-aggression, and sleep problems resulting from both conditions.

    “The presence of GI disorders together with food selectivity could constitute a specific clinical phenotype [31,127,135], characterized by frequent problematic behaviors, such as anxiety, self-aggression, sleep problems, resulting from both conditions [136].”

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  1. [1]American Psychiatric Association AP Diagnostic and Statistical Manual of Mental Disorders 1994 Washington, DC Fourth Edition ed.

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Authors
Ibrahim, S. H., Voigt, R. G., Katusic, S. K., Weaver, A. L., & Barbaresi, W. J.
Affiliations
Mayo Clinic (US)
Venue
PEDIATRICS
Published
2009-08-01
Volume
124
Issue
2
Pages
680-686
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
OpenAlex
W2098616183
Cited by
298
References
37
Citations by year
2026: 6 · 2025: 6 · 2024: 9 · 2023: 12 · 2022: 11 · 2021: 19 · 2020: 20 · 2019: 21 · 2018: 15 · 2017: 17 · 2016: 22 · 2015: 24 · 2014: 15 · 2013: 34 · 2012: 27
FWCI
13.36
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Zorginstituut Nederland
  • National Institutes of Health
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR030582, AR30582)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
autism spectrum disorder, gastrointestinal symptoms, constipation, diarrhea, bloating, gastroesophageal reflux, vomiting, picky eating, cumulative incidence, children
MeSH terms
Adolescent, Autistic Disorder, Child, Child, Preschool, Cross-Sectional Studies, Female, Follow-Up Studies, Gastrointestinal Diseases, Humans, Male, Minnesota, Reference Values, Comorbidity, Incidence, Proportional Hazards Models, Odds Ratio, Kaplan-Meier Estimate

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