UNDERSTANDING GUT HEALTH IN CHILDREN WITH AUTISM: NEW PERSPECTIVES AND THERAPEUTIC STRATEGIES
Abstract
Autism Spectrum Disorder (ASD) encompasses a range of neurodevelopmental traits that influence perception, communication, and social interaction, often accompanied by restricted behaviors and sensory sensitivities. This overview examines the relationship between ASD and gastrointestinal (GI) issues, which frequently co-occur and significantly impact quality of life for affected individuals. Gastrointestinal problems including constipation, diarrhea, and food sensitivities are commonly observed in children with ASD. These issues likely result from multiple interacting factors such as microbiota dysbiosis, immune dysregulation, intestinal hyperpermeability, and dietary patterns. Research has identified disrupted gut microbiome profiles in children with ASD, with increased presence of pathogenic bacteria and associated immune reactivity, including anti-gliadin antibodies. Diagnosing GI disorders in individuals with ASD remains challenging due to communication barriers and atypical sensory processing, with no standardized diagnostic methods currently available. Treatment approaches focus on microbiota restoration through dietary modifications, probiotics, and emerging therapies like Microbiota Transplant Therapy (MTT). Recent studies of MTT have demonstrated sustained improvements in both GI and behavioral symptoms, suggesting promising directions for future interventions that address both the gastrointestinal and behavioral aspects of ASD. Further research is needed to develop standardized diagnostic protocols and evidence-based treatments for this population.
References
Adams, J. B., Borody, T. J., Kang, D. W., Khoruts, A., Krajmalnik-Brown, R., & Sadowsky, M. J. (2019). Microbiota transplant therapy and autism: lessons for the clinic. Expert Review of Gastroenterology and Hepatology, 13(11), 1033–1037. https://doi.org/10.1080/17474124.2019.1687293
Beltagi, M., Saeed, N. K., Bediwy, A. S., Elbeltagi, R., & Alhawamdeh, R. (2023). Role of gastrointestinal health in managing children with autism spectrum disorder. World Journal of Clinical Pediatrics, 12(4), 171–196. https://doi.org/10.5409/wjcp.v12.i4.171
Bernier, R., Golzio, C., Xiong, B., Stessman, H. A., Coe, B. P., Penn, O., Witherspoon, K., Gerdts, J., Baker, C., Vulto-Van Silfhout, A. T., Schuurs-Hoeijmakers, J. H., Fichera, M., Bosco, P., Buono, S., Alberti, A., Failla, P., Peeters, H., Steyaert, J., Vissers, L. E. L. M., … Eichler, E. E. (2014). Disruptive CHD8 mutations define a subtype of autism early in development. Cell, 158(2), 263–276. https://doi.org/10.1016/j.cell.2014.06.017
Bravo, J. A., Forsythe, P., Chew, M. v, Escaravage, E., Savignac, H. M., Dinan, T. G., Bienenstock, J., & Cryan, J. F. (2011). Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proceedings of the National Academy of Sciences, 108(38), 16050–16055. https://doi.org/10.1073/pnas.1102999
Ferguson, B. J., Marler, S., Altstein, L. L., Lee, E. B., Mazurek, M. O., McLaughlin, A., Macklin, E. A., McDonnell, E., Davis, D. J., Belenchia, A. M., Gillespie, C. H., Peterson, C. A., Bauman, M. L., Margolis, K. G., Veenstra-VanderWeele, J., & Beversdorf, D. Q. (2016). Associations between cytokines, endocrine stress response, and gastrointestinal symptoms in autism spectrum disorder. Brain, Behavior, and Immunity, 58, 57–62. https://doi.org/10.1016/j.bbi.2016.05.009
Garcia-Gutierrez, E., Narbad, A., & Rodríguez, J. M. (2020). Autism Spectrum Disorder Associated With Gut Microbiota at Immune, Metabolomic, and Neuroactive Level. Frontiers in Neuroscience, 14. https://doi.org/10.3389/fnins.2020.578666
Holingue, C., Newill, C., Lee, L. C., Pasricha, P. J., & Daniele Fallin, M. (2018). Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism Research, 11(1), 24–36. https://doi.org/10.1002/aur.1854
Hsiao, E. Y. (2014). Gastrointestinal issues in autism spectrum disorder. Harvard Review of Psychiatry, 22(2), 104–111. https://doi.org/10.1097/HRP.0000000000000029
Kang, D. W., Adams, J. B., Coleman, D. M., Pollard, E. L., Maldonado, J., McDonough-Means, S., Caporaso, J. G., & Krajmalnik-Brown, R. (2019). Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Scientific Reports, 9(1). https://doi.org/10.1038/s41598-019-42183-0
Kang, D. W., Adams, J. B., Gregory, A. C., Borody, T., Chittick, L., Fasano, A., Khoruts, A., Geis, E., Maldonado, J., McDonough-Means, S., Pollard, E. L., Roux, S., Sadowsky, M. J., Lipson, K. S., Sullivan, M. B., Caporaso, J. G., & Krajmalnik-Brown, R. (2017). Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: An open-label study. Microbiome, 5(1).https://doi.org/10.1186/s40168-016-0225-7
Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., & Trifan, A. (2020). A descriptive review on the prevalence of gastrointestinal disturbances and their multiple associations in autism spectrum disorder. Medicina, 56(1). https://doi.org/10.3390/medicina56010011
Madra, M., Ringel, R., & Margolis, K. G. (2021). Gastrointestinal Issues and Autism Spectrum Disorder. Psychiatric Clinics of North America, 44(1), 69–81. https://doi.org/10.1016/j.psc.2020.11.006
Marler, S., Ferguson, B. J., Lee, E. B., Peters, B., Williams, K. C., McDonnell, E., Macklin, E. A., Levitt, P., Margolis, K. G., Beversdorf, D. Q., & Veenstra-VanderWeele, J. (2017). Association of rigid-compulsive behavior with functional constipation in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(6), 1673–1681. https://doi.org/10.1007/s10803-017-3084-6
Martínez-González, A. E., Cervin, M., & Pérez-Sánchez, S. (2024). Assessing gastrointestinal symptoms in people with autism: Applying a new measure based on the Rome IV criteria. Digestive and Liver Disease, Volume 56, Issue 11, 1863 - 1870 https://doi.org/10.1016/j.dld.2024.05.019
Santocchi, E., Guiducci, L., Fulceri, F. et al. Gut to brain interaction in Autism Spectrum Disorders: a randomized controlled trial on the role of probiotics on clinical, biochemical and neurophysiological parameters. BMC Psychiatry 16, 183 (2016). https://doi.org/10.1186/s12888-016-0887-5
Saurman, V., Margolis, K. G., & Luna, R. A. (2020). Autism Spectrum Disorder as a Brain-Gut-Microbiome Axis Disorder. Digestive Diseases and Sciences, 65(3), 818–828. https://doi.org/10.1007/s10620-020-06133-5
Marler, S.; Ferguson, B.J.; Lee, E.B.; Peters, B.; Williams, K.C.; McDonnell, E.; Macklin, E.A.; Levitt, P.;Gillespie, C.H.; Anderson, G.M.; et al. Brief Report: Whole Blood Serotonin Levels and Gastrointestinal Symptoms in Autism Spectrum Disorder. J. Autism Dev. Disord. 2016, 46, 1124–1130. https://doi.org/10.1007/s10803-015-2646-8
Horvath K, Papadimitriou JC, Rabsztyn A, Drachenberg C, Tildon JT. Gastrointestinal abnormalities in children with autistic disorder. J Pediatr 1999;135:559–63. https://doi.org/10.1016/S0022-3476(99)70052-1
Coury DL, Ashwood P, Fasano A, et al. Gastrointestinal conditions in children with autism spectrum disorder: developing a research agenda. Pediatrics 2012;130 suppl 2:S160–8. https://doi.org/10.1542/peds.2012-0900N
Li, Q., Han, Y., Dy, A. B. C., & Hagerman, R. J. (2017). The gut microbiota and autism spectrum disorders. Frontiers in Cellular Neuroscience, 11, 120. https://doi.org/10.3389/fncel.2017.00120
Fulceri, F., Morelli, M., Santocchi, E., Cena, H., del Bianco, T., Narzisi, A., Calderoni, S., & Muratori, F. (2016). Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Digestive and Liver Disease, 48(3), 248–254. https://doi.org/10.1016/j.dld.2015.11.026
Adams, J.B., Johansen, L.J., Powell, L.D. et al. Gastrointestinal flora and gastrointestinal status in children with autism – comparisons to typical children and correlation with autism severity. BMC Gastroenterol 11, 22 (2011). https://doi.org/10.1186/1471-230X-11-22
Furuta, G. T., Williams, K., Kooros, K., Kaul, A., Panzer, R., Coury, D. L., & Fuchs, G. (2012). Management of Constipation in Children and Adolescents With Autism Spectrum Disorders. Pediatrics, 130(Supplement 2), S98–S105 https://doi.org/10.1542/peds.2012-0900h
Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2014). Gastrointestinal problems in children with autism, developmental delays or typical development. Journal of Autism and Developmental Disorders, 44(5), 1117-1127. https://doi.org/10.1007/s10803-013-1973-x
Gorrindo, P., Williams, K. C., Lee, E. B., Walker, L. S., McGrew, S. G., & Levitt, P. (2012). Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors. Autism Research, 5(2), 101-108. https://doi.org/10.1002/aur.237
Restrepo, B., Angkustsiri, K., Taylor, S. L., Rogers, S. J., Cabral, J., Heath, B., Hechtman, A., Solomon, M., Ashwood, P., Nordahl, C. W., & de Water, J. V. (2020). Developmental–behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Research, 13(10), 1778-1789. https://doi.org/10.1002/aur.2354
Sanctuary, M. R., Kain, J. N., Angkustsiri, K., & German, J. B. (2018). Dietary considerations in autism spectrum disorders: The potential role of protein digestion and microbial putrefaction in the gut-brain axis. Frontiers in Nutrition, 5, 40. https://doi.org/10.3389/fnut.2018.00040
Kaluzna-Czaplinska J, Blaszczyk S. (2012) The level of arabinitol in autistic children after probiotic therapy. Nutrition 28:124–6. https://doi.org/10.1016/j.nut.2011.08.002
Rose, D. R., Yang, H., Serena, G., Sturgeon, C., Ma, B., Careaga, M., Hughes, H. K., Angkustsiri, K., Rose, M., Hertz-Picciotto, I., van de Water, J., Hansen, R. L., Ravel, J., Fasano, A., & Ashwood, P. (2018). Differential immune responses and microbiota profiles in children with autism spectrum disorders and co-morbid gastrointestinal symptoms. Brain, Behavior, and Immunity, 70, 354-368. https://doi.org/10.1016/j.bbi.2018.03.025
Strati, F., Cavalieri, D., Albanese, D., De Felice, C., Donati, C., Hayek, J., Jousson, O., Leoncini, S., Renzi, D., Calabrò, A., & De Filippo, C. (2017). New evidences on the altered gut microbiota in autism spectrum disorders. Microbiome, 5(1), 24. https://doi.org/10.1186/s40168-017-0242-1
Views:
81
Downloads:
55
Copyright (c) 2025 Joanna Kośka, Gabriela Łocik, Katarzyna Moliszewska, Paweł Kukiełka, Julia Mazurek, Julia Załęcka, Alicja Nowik, Kacper Dywan, Martyna Musiorska, Michał Błaszkiewicz
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
