https://orcid.org/0000-0003-1100-101X
Dear editor
Moudgal et al published an article in Clinical and Experimental Gastroenterology titled “Systemic Disease Associations with Disorders of Gut–Brain Interaction and Gastrointestinal Transit: A Review”.Citation1 We want to express our gratitude to the authors for publishing such a thorough review study and would like to make some suggestions.
The paper discussed a variety of multisystem illnesses and their pathophysiological links to disorders of gut brain interface (DGBI) and gastrointestinal motor dysfunction, presenting gastroenterologists with a foundation for differential diagnosis.Citation1
Although the article mentioned most of the systemic disorders, we noticed the lack of the overlap of GI symptoms and autism spectrum disorder (ASD) core symptoms.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder which manifests as variable phenotypes with different subendo-phenotypes that may represent GI abnormalities. A meta-analysis carried out in 2014 by McElhanon et al, showed that children with ASD, unlike the comparison groups, expressed significantly more general GI symptoms: diarrhea, abdominal pain, and constipation.Citation2 Recent studies have shown the shared pathogenic factors and pathophysiological mechanisms revealing the possible link between GI and ASD disturbances, including inflammation of intestine with or without autoimmunity, visceral hypersensitivity with functional abdominal pain and autonomic dysfunction with GI reflux and dysmotility. Absent or slow acquirement of bowel training secondary to trouble with sensory processing and motor problems may lead to altered GI motility and defecation physiology.Citation3 Research carried out by Afzal et al concluded moderate-to-severe constipation in 36% of children with ASD compared to 9% in a control population.Citation4
The diagnosis of GI disorders in patients with ASD can be very challenging due to the behavioral expressions, thus, doctors recommend using less invasive methods of investigation before hospitalization.Citation5
In his research, Wasilewska et al concluded that GI disorders in children with ASD may vary greatly in their nature and localization. Due to the phenotypical representation as comorbidity of ASD and GI disorders, we suggest treating this situation as an “overlap syndrome”.Citation2
Children with ASD who have GI disease and are experiencing unexplained anxiety, self-injury, sleep deprivation, aggression, and agitation will benefit from this concept. We have made significant progress in our studies of ASD; however, more research and systemic research are needed to determine the extent to which GI and ASD are linked.
Disclosure
The authors report no conflicts of interest for this communication.
References
- Moudgal R, Schultz AW, Shah ED. Systemic disease associations with disorders of gut–brain interaction and gastrointestinal transit: a review. Clin Exp Gastroenterol. 2021;14:249. doi:10.2147/CEG.S283685
- McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133(5):872–883. doi:10.1542/peds.2013-3995
- Wasilewska J, Klukowski M. Gastrointestinal symptoms and autism spectrum disorder: links and risks–a possible new overlap syndrome. Pediatric Health Med Ther. 2015;6:153. doi:10.2147/PHMT.S85717
- Afzal N, Murch S, Thirrupathy K, Berger L, Fagbemi A, Heuschkel R. Constipation with acquired megarectum in children with autism. Pediatrics. 2003;112(4):939–942. doi:10.1542/peds.112.4.939
- Buie T, Fuchs GJ, Furuta GT, et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics. 2010;125(Supplement 1):S19–29. doi:10.1542/peds.2009-1878D