Gastrointestinal abnormalities in children with autistic disorder

Objectives: Our aim was tb evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastroin testinal symptoms. Study design: Thirty-six children (age: 5.7 +/- 2 years, mean It SD) with a utistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal culture s. The most frequent gastrointestinal complaints were chronic diarrhea, gas eousness, and abdominal discomfort and distension. Results: Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duo denitis in 24. The number of Paneth's cells in the duodenal crypts was sign ificantly elevated in autistic children compared with non-autistic control subjects. Low intestinal carbohydrate digestive enzyme activity was reporte d in 21 children (58.3%), although there was no abnormality found in pancre atic function. Seventy-five percent of the autistic children (27/36) had an increased pancreatico-biliary fluid output after intravenous secretin admi nistration. Nineteen of the 21 patients with diarrhea had significantly hig her fluid output than those without diarrhea. Conclusions: Unrecognized gastrointestinal disorders, especially reflux eso phagitis and disaccharide malabsorption, may contribute to the behavioral p roblems of the non-verbal autistic patients. The observed increase in pancr eatico-biliary secretion after secretin infusion suggests an upregulation o f secretin receptors in the pancreas and liver. Further studies are require d to determine the possible association between the brain and gastrointesti nal dysfunctions in children with autistic disorder.