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Prevalence of Gastrointestinal Problems in Individuals with Autism Compared to Those with Other Developmental Disorders and Typically-Developing Controls
Gastrointestinal (GI) problems such as chronic constipation, abdominal pain, diarrhea, and gastroesophageal reflux disease are commonly reported in children with autism spectrum disorder (ASD). Prevalence estimates of GI disorders in children with ASD vary widely, from 9% to over 90%. These disparate findings may result from differences in methodology across studies.
Objectives:
This study describes the prevalence of GI problems in children with ASD and other developmental disorders compared to typically-developing children using electronic health record (EHR) data from a large health system.
Methods:
This is a retrospective study using data extracted from the Geisinger EHR. Participants included children (ages 3-18 years) with one or more of the following diagnoses: ASD, Global developmental delay/Intellectual disability (DD/ID), Language disorder (LD), Cerebral palsy (CP). The following data elements were extracted from the EHR, using information previously collected from clinical care: aggregated GI diagnoses (ICD-9 codes 530-579, 787), GI studies/procedures, GI medication prescriptions, and GI consultations.
Participants were divided into five independent diagnostic groups (ASD [without DD/ID]; ASD [with DD/ID]; DD/ID [without ASD]; LD [without ASD or DD/ID]; and CP [without ASD, DD/ID, or LD]), two summary groups (any ASD; non-ASD diagnosis), along with age and gender-matched controls. Through chi-squared analysis, the prevalence of any GI diagnosis, procedure, medication, and consultation was compared between: participants in each diagnostic group compared to controls; and any ASD compared to any non-ASD diagnosis.
Results:
Data was available from 46,996 children: ASD without DD/ID (5,429); ASD with ID/DD (1,709); DD/ID (5,928); LD (9,392); CP (1,040); Controls (23,498). Children in all of the diagnostic groups were significantly more likely (p<0.05) to have a GI diagnosis, undergo a GI procedure, be prescribed a GI medication, or be referred for GI consultation compared to controls. Children with one of the non-ASD conditions (DD/ID, LD, or CP) were significantly more likely (p<0.05) than children with ASD (with or without DD/ID) to have a GI diagnosis, undergo a GI procedure, be prescribed a GI medication, or be referred for GI consultation.
Conclusions:
Previous studies have suggested that GI problems are more common in children with ASD than in unaffected siblings, typically-developing children, and children with other developmental disorders. However, many of these studies were based on parental report, which could introduce recall bias. This study expands and refines the understanding of the prevalence of GI disorders in ASD compared to other developmental disorders using EHR data from a large health system. Overall, children with ASD (with and without DD/ID) and other developmental disorders were more likely than controls to have evidence of a GI disorder. However, the increase in GI disorders was not unique to ASD; children with other developmental diagnoses had an even higher rate of GI disorders. In addition to informing future research methodology, these findings provide important information that will allow healthcare providers to better anticipate the medical needs of children with ASD or other developmental disorders.