Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis

Pediatrics. 2014 May;133(5):872-83. doi: 10.1542/peds.2013-3995.


Background: In pediatric settings, parents often raise concerns about possible gastrointestinal (GI) symptoms in autism spectrum disorder (ASD), yet the specificity of these concerns are not well studied.

Objective: To conduct a meta-analysis of research investigating GI symptoms among children with ASD.

Methods: We searched Medline, PsycINFO, and PubMed databases (1980-2012) in peer-reviewed journals. Analysis involved studies with a comparison group presenting quantitative data on GI symptoms using combinations of terms for ASD and GI indicators. The systematic search yielded 15 studies. We calculated effect sizes and 95% confidence intervals (CIs) using a random-effects model.

Results: Children with ASD experience significantly more general GI symptoms than comparison groups, with a standardized mean difference of 0.82 (0.24) and a corresponding odds ratio (OR) of 4.42 (95% CI, 1.90-10.28). Analysis also indicated higher rates of diarrhea (OR, 3.63; 95% CI, 1.82-7.23), constipation (OR, 3.86; 95% CI, 2.23-6.71), and abdominal pain (OR, 2.45; 95% CI, 1.19-5.07).

Conclusions: Results indicate greater prevalence of GI symptoms among children with ASD compared with control children. Identified studies involved high methodological variability and lack of comprehensive data prohibited analysis of GI pathophysiologies (eg, gastroesophageal reflux) typically associated with organic etiologies, limiting conclusions about the underpinnings of the observed association. Future research must address critical questions about the causes and long-term impact of GI symptoms in ASD. Such analyses will require more systematic research and clinical activities, including improved diagnostic screening, standardized assessment, and exploration of potential moderators (eg, dietary restrictions).

Keywords: GI; autism spectrum disorder; constipation; digestive disorders.

Publication types

  • Meta-Analysis

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / epidemiology
  • Adolescent
  • Child
  • Child Development Disorders, Pervasive / diagnosis*
  • Child Development Disorders, Pervasive / epidemiology
  • Child, Preschool
  • Comorbidity
  • Constipation / diagnosis
  • Constipation / epidemiology
  • Diarrhea / diagnosis
  • Diarrhea / epidemiology
  • Enterocolitis / diagnosis
  • Enterocolitis / epidemiology
  • Female
  • Gastrointestinal Diseases / diagnosis*
  • Gastrointestinal Diseases / epidemiology
  • Humans
  • Infant
  • Male
  • Odds Ratio
  • Risk