New tool assesses gastrointestinal health of people with autism

Gastrointestinal symptoms are common in individuals with autism spectrum disorder (ASD). However, the communication and social interaction difficulties associated with this condition complicate the assessment of these symptoms and their severity. A new tool has been developed to facilitate this stage: the Gastrointestinal Symptom Severity Scale (GSSS). Between 40% and 70% of people with ASD suffer from gastrointestinal problems. These are more severe and more frequent than in the general population. Strict dietary selection or restriction may explain the presence of these symptoms, but anxiety and reactivity to sensations may also be involved.While a number of tools already exist to assess functional gastrointestinal disorders, none of them is specifically aimed at people with ASD, said the creators of the GSSS, which was developed in Spain. While the Gastrointestinal Severity Index (GSI) has been used with autistic children, it does not specifically measure the severity of symptoms. Rating symptomsThe aim was therefore to create a tool for both pediatric and adult populations that takes into account the specific features of autism spectrum disorders. Based on the Rome IV diagnostic criteria for functional gastrointestinal disorders, the GSSS includes several symptoms, including constipation, diarrhea, stool consistency, stool odour, flatulence and gas, and abdominal pain. Each symptom is rated on a scale of 0 to 3 according to the frequency or degree of discomfort experienced by patients. To validate the relevance of the tool and its application in patients, 265 individuals aged three to 41 with a diagnosis of ASD completed the questionnaire. The results were published in Digestive and Liver Disease and revealed that around 40% of patients had difficulties with one or more gastrointestinal disorders, which is consistent with figures from previous studies on the subject. Constipation and abdominal pain were among the most frequent symptoms. After analysis, the GSSS was found to be consistent and reliable, as well as having strong convergent validity compared with other tests. “Our data confirms the association between restrictive eating behaviours due to hypersensitivity and increased gastrointestinal symptoms and pain in people with ASD,” the researchers noted. For example, patients who were fussier about food had more gastrointestinal problems.Understanding gut-brain connectionAbove all, the GSSS proved to be a strong predictor of the degree of severity of ASD. Indeed, a link has been established between severe gastrointestinal symptoms and more intense autistic traits, heightened sensory reactivity and repetitive behaviours.This reinforces the hypothesis of a gut-brain connection to explain the wide variability in symptoms in people with ASD. Numerous studies suggest that dysfunctions linked to the gastrointestinal system contribute to the clinical manifestations of certain symptoms of autism. There is even evidence of a signature composition of the intestinal microbiota of people with ASD, but its role has yet to be defined.“The impact of gastrointestinal symptoms in children and adolescents with autism has been little studied. We believe that GSSS could help advance knowledge of the gut-brain connection in autism spectrum disorder,” the researchers concluded.

New tool assesses gastrointestinal health of people with autism

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