Williams BL, Hornig M, Parekh T, Lipkin WI.MBio. Application of novel PCR-based methods for detection, quantitation, and phylogenetic characterization of Sutterella species in intestinal biopsy samples from children with autism and gastrointestinal disturbances. 2012 Jan 10;3(1). pii: e00261-11. doi: 10.1128/mBio.00261-11.
This article identifies a "new" gut bug- Sutterella- as being prevalent in the GI tracts of kids with autism.  Here is a link to the full text.

New Report Outlines Evaluation, Diagnosis and Treatment of Gastrointestinal Issues in Children with Autism

Commonly Reported Symptoms Often Untreated Due to Communication Issues

Bethesda, MD (January 4, 2010) - A report released today in the journal Pediatrics offers consensus statements and recommendations for evaluating, diagnosing and treating gut issues often reported in children with autism spectrum disorders (ASD). Critically, it notes that even though the communication difficulties associated with ASD can cause difficulty in recognizing gastrointestinal (GI) disorders, individuals with ASD deserve to receive the same thorough diagnostic workup and treatment of GI issues as their typical peers. Achieving this level of care would be a great improvement over the present situation for individuals with ASD.

Further, the study reports that some problem behaviors in patients with ASD may be the result of an underlying medical condition, such as a GI disorder, and that for these patients, integrating behavioral and medical care may be beneficial.

"For years, families have reported that their children are struggling with destructive gut issues that affect their behavior and their quality of life," said Autism Society President and CEO Lee Grossman. "This study is tremendously significant in that it brings a roadmap of options for talented professionals of many disciplines to work together to make children with autism healthy. By improving their health, we can possibly reduce the more negative aspects of the condition and help individuals with autism achieve their maximum potential."

The research and recommendations presented in the report are the result of consensus conferences conducted by a multi-disciplinary panel of top clinicians and researchers working with autism spectrum disorders, sponsored by the Autism Society, the Northwest Autism Foundation, the Autism Research Institute and Easter Seals of Oregon.

"This study emphasizes the importance of looking for underlying gastrointestinal and other medical conditions in patients with ASD," said Dr. Tim Buie, a pediatric gastroenterologist at Mass General Hospital and Harvard Medical School, Autism Society 2009 Professional of the Year and co-chair of the consensus report. "Individuals with ASD often cannot verbalize their pain, and are left with behaviors that people often write off as simply an effect of autism. By identifying and treating these co-morbid factors, we can often eliminate a huge barrier to their progress and quality of life."

The first report, entitled Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report, involved a number of working groups to evaluate the available literature. The working groups then summarized findings and developed consensus statements based on the reviews. Their key conclusions include:

  • Individuals with ASD whose families report GI symptoms warrant a thorough GI evaluation;
  • The communication impairments characteristic of ASDs may lead to unusual presentations of GI disorders, including sleep disturbances and problem behaviors;
  • Caregivers and health care professionals should be alert to atypical signs of GI disorders in patients with ASDs; and
  • Integrating behavioral and biomedical approaches can be helpful in figuring out the role of pain as a contributing factor in problem behavior, facilitating diagnosis and addressing symptoms to enhance quality of life.
  • While the panel acknowledged that there are currently few evidence-based studies, they did identify a number of specific areas in need of further research. These include determining the prevalence of GI disorders in individuals with ASD, identifying behaviors likely to be associated with GI pain in individuals with ASD, and a developing a screening instrument for GI disorders in individuals with ASD-especially to identify those whose symptoms may not be obvious.

Though the consensus report could not determine the specific prevalence of GI issues in autism, it is clear that there are a significant number of children with ASD with common gastrointestinal problems who are not being treated for chronic pain. With the new prevalence rate of autism in the U.S. at one in every 110 children, the Autism Society hopes that this study and others like it will lead to better diagnostics of the medical conditions that can co-occur with autism, and that increased awareness among both families as well as healthcare providers will lead to better diagnosis and treatment.

The second article, Recommendations for Evaluation and Treatment of Common Gastrointestinal Problems in Children With ASDs, is a review by eight pediatric gastroenterologists of current published guidelines and recommendations for the management of GI symptoms that occur frequently in the general population that have been adapted for diagnostic evaluation and treatment of GI problems in children with ASDs. It presents their recommendations for chronic abdominal pain, chronic constipation, chronic diarrhea, and symptoms of gastroesophageal reflux.

Both studies are available at http://pediatrics.aappublications.org. For more information or to schedule interviews with autism experts, please contact Autism Society Media Specialist Carin Yavorcik at 419-787-8146 or cyavorcik@autism-society.org, or Autism Society Vice President of Constituent Relations Marguerite Kirst Colston at 240-672-4734 or mcolston@autism-society.org.

BMC Gastroenterol. 2011 Mar 16;11(1):22.

Gastrointestinal flora and gastrointestinal status in children with autism -- comparisons to typical children and correlation with autism severity.

Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA.

School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ, USA. Jim.Adams@asu.edu.


BACKGROUND: Children with autism have often been reported to have gastrointestinal problems that are more frequent and more severe than in children from the general population.

METHODS: Gastrointestinal flora and gastrointestinal status were assessed from stool samples of 58 children with Autism Spectrum Disorders (ASD) and 39 healthy typical children of similar ages. Stool testing included bacterial and yeast culture tests, lysozyme, lactoferrin, secretory IgA, elastase, digestion markers, short chain fatty acids (SCFA's), pH, and blood presence. Gastrointestinal symptoms were assessed with a modified six-item GI Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with the Autism Treatment Evaluation Checklist (ATEC).

RESULTS: Gastrointestinal symptoms (assessed by the 6-GSI) were strongly correlated with the severity of autism (assessed by the ATEC), (r = 0.59, p < 0.001). Children with 6-GSI scores above 3 had much higher ATEC Total scores than those with 6-GSI-scores of 3 or lower (81.5 +/- 28 vs. 49.0 +/- 21, p = 0.00002).Children with autism had much lower levels of total short chain fatty acids (-27%, p = 0.00002), including lower levels of acetate, proprionate, and valerate; this difference was greater in the children with autism taking probiotics, but also significant in those not taking probiotics. Children with autism had lower levels of species of Bifidobacter (-43%, p = 0.002) and higher levels of species of Lactobacillus (+100%, p = 0.00002), but similar levels of other bacteria and yeast using standard culture growth-based techniques. Lysozyme was somewhat lower in children with autism (-27%, p = 0.04), possibly associated with probiotic usage. Other markers of digestive function were similar in both groups.

CONCLUSIONS: The strong correlation of gastrointestinal symptoms with autism severity indicates that children with more severe autism are likely to have more severe gastrointestinal symptoms and vice versa. It is possible that autism symptoms are exacerbated or even partially due to the underlying gastrointestinal problems. The low level of SCFA's was partly associated with increased probiotic use, and probably partly due to either lower production (less sacchrolytic fermentation by beneficial bacteria and/or lower intake of soluble fiber) and/or greater absorption into the body (due to longer transit time and/or increased gut permeability).


PDF available at:  http://www.biomedcentral.com/1471-230X/11/22


The gastrointestinal system's association with autism. [Article in Danish]

Schnohr CW. Ugeskr Laeger. 2011 Feb 21;173(8):581-3.

Institut for Folkesundhedsvidenskab,Københavns Universitet, Østerbrogade 41, København Ø, Denmark. christina@schnohr.dk


Autism was first described by Leo Kanner in 1943. He described common features in 11 children, who were, among others, characterised by limited social interaction and lack of communicative skills. However, Kanner also described characteristics related to the gastrointestinal system. Subsequently, studies have related autism to chronic inflammation in the intestinal lining and to food allergies. If the severity of autism is affected, e.g. by a pathological gastrointestinal condition, there is a possibility that treatment of the secondary condition will lead to improvement in the primary ailment followed by increased well-being.

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