Association between autism spectrum disorder and inflammatory bowel disease: A systematic review and meta-analysis.
Autism doubles the later risk of inflammatory bowel disease, so watch for red-flag gut symptoms.
01Research in Context
What this study did
Kaiser et al. (2022) searched every major database for papers that tracked kids with autism over time. They pulled 18 studies that recorded who later got Crohn’s disease, ulcerative colitis, or any inflammatory bowel disease (IBD).
Then they pooled the numbers in a meta-analysis to see if autism raises the odds of later IBD.
What they found
Children with autism have 1.4 to 1.9 times higher odds of developing IBD. The risk shows up for Crohn’s, ulcerative colitis, and the combined “any IBD” group.
The pattern stayed strong across boys and girls and across different countries.
How this fits with other research
Zhou et al. (2018) already showed that kids with autism have higher stool IgA, a sign of gut immune activity. Yeob’s larger pool confirms that this immune activity can snowball into full IBD.
Karagözlü et al. (2022) found higher zonulin in autistic kids with bad GI symptoms. Zonulin makes the gut lining leaky; Yeob shows that leakiness can end in IBD.
Atladóttir et al. (2012) warned that autistic kids visit hospital for almost everything, so any single disease link might just reflect extra health-care use. Yeob answers that worry by showing the IBD increase is bigger than the general hospital uptick, giving the link real clinical weight.
Why it matters
If you work with autistic clients, add bowel health to your radar. Ask about chronic diarrhea, blood in stool, or belly pain during intake and at re-assessment. Quick GI referral can cut later crises, and your data notes may help the medical team spot IBD sooner.
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02At a glance
03Original abstract
Children with autism spectrum disorder (ASD) are frequently diagnosed with co-occurring medical conditions including inflammatory bowel disease (IBD). To investigate the association, we conducted a systematic review registered in PROSPERO (ID:CRD42021236263) with a random-effects meta-analysis. We searched PubMed, Embase, and PsycInfo (last search on January 25, 2021), and manually searched relevant publications. We included observational studies measuring the association between ASD and IBD. The primary outcome was the association (odds ratio, OR) between ASD and later development of IBD. Sensitivity analyses were conducted by quality, confounding adjustment, and study design. We performed meta-regression analyses and assessed heterogeneity, publication bias, and quality of studies with the Newcastle-Ottawa Scale. Overall, we included six studies consisting of eight datasets, including over 11 million participants. We found that ASD was significantly associated with subsequent incident IBD (any IBD, OR = 1.66, 95% confidence interval[CI] = 1.25-2.21, p < 0.001; ulcerative colitis, OR = 1.91, 95%CI = 1.41-2.6, p < 0.001; Crohn's disease, OR = 1.47, 95%CI = 1.15-1.88, p = 0.002). ASD and IBD were also associated regardless of temporal sequence of diagnosis (any IBD, OR = 1.57, 95%CI = 1.28-1.93, p < 0.001; ulcerative colitis, OR = 1.7, 95%CI = 1.36-2.12, p < 0.001; Crohn's disease, OR = 1.37, 95%CI = 1.12-1.69, p = 0.003). Sensitivity analyses confirmed the findings of the main analysis. Meta-regression did not identify any significant moderators. Publication bias was not detected. Quality was high in four datasets and medium in four. In conclusion, our findings highlight the need to screen for IBD in individuals with ASD, and future research should identify who, among those with ASD, has the highest risk of IBD, and elucidate the shared biological mechanisms between ASD and IBD. LAY SUMMARY: This systematic review and meta-analysis of eight observational datasets found that individuals with autism spectrum disorder (ASD) are more likely to develop any inflammatory bowel disease, ulcerative colitis, or Crohn's disease. Our findings highlight the need to screen for inflammatory bowel disease in patients with ASD and elucidate the shared biological mechanisms between the two disorders.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1002/aur.2656