Krigsman A, Walker SJ. Gastrointestinal disease in children with autism spectrum disorders: Etiology or consequence? World J Psychiatr 2021; 11(9): 605-618 [PMID: 34631464 DOI: 10.5498/wjp.v11.i9.605]
Corresponding Author of This Article
Stephen J Walker, PhD, Professor, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, United States. swalker@wakehealth.edu
Research Domain of This Article
Psychiatry
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatr. Sep 19, 2021; 11(9): 605-618 Published online Sep 19, 2021. doi: 10.5498/wjp.v11.i9.605
Gastrointestinal disease in children with autism spectrum disorders: Etiology or consequence?
Arthur Krigsman, Stephen J Walker
Arthur Krigsman, Pediatric Gastroenterology Resources of New York and Texas, Georgetown, TX 78628, United States
Stephen J Walker, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
Author contributions: Krigsman A and Walker SJ contributed equally to this work; both authors have read and approve the final manuscript.
Conflict-of-interest statement: No conflicts-of-interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stephen J Walker, PhD, Professor, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, United States. swalker@wakehealth.edu
Received: June 2, 2021 Peer-review started: June 2, 2021 First decision: June 23, 2021 Revised: June 24, 2021 Accepted: August 12, 2021 Article in press: August 12, 2021 Published online: September 19, 2021
Abstract
Chronic gastrointestinal (GI) symptoms and disorders are common in children with autism spectrum disorder and have been shown to be significantly correlated with the degree of behavioral and cognitive impairment. In this unique population, GI symptoms often arise very early in development, during infancy or toddlerhood, and may be misdiagnosed - or not diagnosed at all – due in part to the challenges associated with recognition of symptoms in a minimally or non-communicative child. Evidence demonstrating that the gut-brain-axis can communicate gut dysbiosis and systemic immune dysregulation in a bidirectional manner raises the question as to whether an untreated gastrointestinal disorder can directly impact neurodevelopment or, conversely, whether having a neurodevelopmental disorder predisposes a child to chronic GI issues. From the data presented in this mini review, we conclude that the preponderance of available evidence would suggest the former scenario is more strongly supported.
Core Tip: Children with autism spectrum disorder are at a significantly increased risk for chronic gastrointestinal issues from an early age. Clinicians and caregivers should be made aware of this association and provided with the tools necessary for recognition of gastrointestinal (GI) symptoms in these children. Because the first several years is a critical developmental window in the life of a child, and because of the demonstrated correlation between GI symptom severity and severity of autism spectrum disorder behaviors and cognition, it is plausible that a neurodevelopmental diagnosis may result from an untreated, persistent state of GI/immune dysregulation.
