Autism spectrum disorders (ASDs)—commonly referred to as autism—are conditions characterized by impairment of social interaction and of verbal and non-verbal communication, poor social skills, a limited range of interests, and repetitive behaviors. ASDs etiology is heterogeneous and presents a complex interplay among contributing genetic and environmental factors. ASDs prevalence is 60-70/10.000. In the past few years, ASDs prevalence has increased, due to a better diagnosis sensibility and the contribution of additional environmental factors to ASDs occurrence. Patients affected by autism may also present several medical diseases. A correct medical treatment of these diseases may improve the quality of life, well-being, and behavior of the patients affected, and may also positively impact upon the behavioral and educational treatments. An accurate recognition of the medical diseases associated with autism may also help to identify subgroups of ASDs with homogeneous phenotypic and genetic characteristics, and may thus foster a better understanding of the possible pathogenetic mechanisms responsible for ASDs. Gastrointestinal (GI) disorders are among the medical pathologies associated with autism. The association of GI disorders and autism is well known, with a symptoms occurrence ranging from 9% to 70% or higher. The GI disorders reported in the literature include gastroesophageal reflux disease, gastritis, esophagitis, inflammatory bowel disease, celiac disease, Crohn’s disease, and colitis. The GI symptoms most frequently identified in connection with autism are constipation, diarrhea, bloating, belching, abdominal pain, reflux, vomiting, and flatulence. The difficulty that ASDs patients frequently encounter to verbally communicate a discomfort caused by a GI disease is often the cause of disturbed or aggressive behavior, hyperactivity, sleep disturbances, and feeding problems. Various hypotheses have been formulated since the 1990s on the etiopathogenetic role played by the interaction between the gut and the brain in causing autistic behaviors. At present, there are no conclusive data on the relation between GI disorders and ASDs, and it is possible that different mechanisms and different genes are implicated in a group of subjects with ASDs, GI and immune system disorders. Variables considered in the gut-brain axis model include bowel inflammatory diseases, food allergies, increased intestinal permeability, the interaction between immunological system and the bloodbrain barrier, microglia, astrocytes, and neuronal modulation; however, more studies are necessary to clarify this relationship. Although evidence-based recommendations for the diagnosis and treatment of ASDs and GI disorders are not yet available, a consensus report by specialists suggests that patients with ASDs receive the same diagnostic workup and guidelines for GI symptoms as pediatric patients without autism. In general, the treatment of GI disorders depends on the underlying dysfunctions that are also diagnosed. At present, even though many anecdotal therapies have been described, it is advisable to use only treatments privileging evidence-based practices with a solid scientific foundation. Further research is needed to clarify the etiopathogenesis and management of GI disorders in autism.
Comprehensive Guide to Autism. Diet and Nutrition in Autism Spectrum Diosrders.
A. Parmeggiani
Writing – Original Draft Preparation
2014
Abstract
Autism spectrum disorders (ASDs)—commonly referred to as autism—are conditions characterized by impairment of social interaction and of verbal and non-verbal communication, poor social skills, a limited range of interests, and repetitive behaviors. ASDs etiology is heterogeneous and presents a complex interplay among contributing genetic and environmental factors. ASDs prevalence is 60-70/10.000. In the past few years, ASDs prevalence has increased, due to a better diagnosis sensibility and the contribution of additional environmental factors to ASDs occurrence. Patients affected by autism may also present several medical diseases. A correct medical treatment of these diseases may improve the quality of life, well-being, and behavior of the patients affected, and may also positively impact upon the behavioral and educational treatments. An accurate recognition of the medical diseases associated with autism may also help to identify subgroups of ASDs with homogeneous phenotypic and genetic characteristics, and may thus foster a better understanding of the possible pathogenetic mechanisms responsible for ASDs. Gastrointestinal (GI) disorders are among the medical pathologies associated with autism. The association of GI disorders and autism is well known, with a symptoms occurrence ranging from 9% to 70% or higher. The GI disorders reported in the literature include gastroesophageal reflux disease, gastritis, esophagitis, inflammatory bowel disease, celiac disease, Crohn’s disease, and colitis. The GI symptoms most frequently identified in connection with autism are constipation, diarrhea, bloating, belching, abdominal pain, reflux, vomiting, and flatulence. The difficulty that ASDs patients frequently encounter to verbally communicate a discomfort caused by a GI disease is often the cause of disturbed or aggressive behavior, hyperactivity, sleep disturbances, and feeding problems. Various hypotheses have been formulated since the 1990s on the etiopathogenetic role played by the interaction between the gut and the brain in causing autistic behaviors. At present, there are no conclusive data on the relation between GI disorders and ASDs, and it is possible that different mechanisms and different genes are implicated in a group of subjects with ASDs, GI and immune system disorders. Variables considered in the gut-brain axis model include bowel inflammatory diseases, food allergies, increased intestinal permeability, the interaction between immunological system and the bloodbrain barrier, microglia, astrocytes, and neuronal modulation; however, more studies are necessary to clarify this relationship. Although evidence-based recommendations for the diagnosis and treatment of ASDs and GI disorders are not yet available, a consensus report by specialists suggests that patients with ASDs receive the same diagnostic workup and guidelines for GI symptoms as pediatric patients without autism. In general, the treatment of GI disorders depends on the underlying dysfunctions that are also diagnosed. At present, even though many anecdotal therapies have been described, it is advisable to use only treatments privileging evidence-based practices with a solid scientific foundation. Further research is needed to clarify the etiopathogenesis and management of GI disorders in autism.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
