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Association of Autism Spectrum Disorders and Inflammatory Bowel Disease

Abstract

Autism spectrum disorders (ASD) and inflammatory bowel disease (IBD) both have multifactorial pathogenesis with an increasing number of studies demonstrating gut-brain associations. We aim to examine the association between ASD and IBD using strict classification criteria for IBD. We conducted a retrospective case-cohort study using records from the Military Health System database with IBD defined as having one encounter with an ICD-9-CM diagnostic code for IBD and at least one outpatient prescription dispensed for a medication to treat IBD. Children with ASD were more likely to meet criteria for Crohn’s disease (CD) and Ulcerative colitis (UC) compared to controls. This higher prevalence of CD and UC in children with ASD compared to controls confirms the association of ASD with IBD.

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References

  1. Adams, J. B., Johansen, L. J., Powell, L. D., Quig, D., & Rubin, R. A. (2011). Gastrointestinal flora and gastrointestinal status in children with autism–comparisons to typical children and correlation with autism severity. BMC Gastroenterol, 11, 22.

  2. American Psychiatric Association, ed. (2013). Diagnostic and statistical manual of mental disorders, 5th edn. Arlington, VA: American Psychiatric Association, pp. 50–51.

  3. Bernstein, C. N., Blanchard, J. F., Rawsthorne, P., & Wajda, A. (1999). Epidemiology of Crohn’s disease and ulcerative colitis in a central Canadian province: A population-based study. American Journal of Epidemiology, 149(10), 916–924.

  4. Burke, J. P., Jain, A., Yang, W., et al. (2014). Does a claims diagnosis of autism mean a true case? Autism, 18(3), 321–330.

  5. Christensen, D. L., Baio, J., Van Naarden Braun, K., et al. (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2012. MMWR Surveillance Summary, 65(3), 1–23.

  6. Coleman, K. J., Lutsky, M. A., Yau, V., et al. (2015). Validation of autism spectrum disorder diagnoses in large healthcare systems with electronic medical records. Journal of Autism and Developmental Disorders, 45(7), 1989–1996.

  7. D’Eufemia, P., Celli, M., Finocchiaro, R., et al. (1996). Abnormal intestinal permeability in children with autism. Acta Paediatrica, 85(9), 1076–1079.

  8. Doshi-Velez, F., Avillach, P., Palmer, N., et al. (2015). Prevalence of inflammatory bowel disease among patients with autism spectrum disorders. Inflammatory Bowel Disease, 21(10), 2281–2288.

  9. Horvath, K., & Perman, J. A. (2002). Autistic disorder and gastrointestinal disease. Current Opinion in Pediatrics, 14(5), 583–587.

  10. Kappelman, M. D., Moore, K. R., Allen, J. K., & Cook, S. F. (2013). Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Digestive Diseases and Sciences, 58(2), 519–525.

  11. Kappelman, M. D., Rifas-Shiman, S. L., Kleinman, K., et al. (2007). The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clinical Gastroenterology and Hepatology, 5(12), 1424–1429.

  12. Kelsen, J., & Baldassano, R. N. (2008). Inflammatory bowel disease: The difference between children and adults. Inflammatory Bowel Disease, 14(Suppl 2), S9–S11.

  13. Kohane, I. S., Mcmurry, A., Weber, G., et al. (2012). The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS ONE. https://doi.org/10.1371/journal.pone.0033224.

  14. Kurti, Z., Vegh, Z., Golovics, P. A., et al. (2016). Nationwide prevalence and drug treatment practices of inflammatory bowel diseases in Hungary: A population-based study based on the National Health Insurance Fund database. Digestive and Liver Disease, 48(11), 1302–1307.

  15. Ludvigsson, J. F., Büsch, K., Olén, O., et al. (2017). Prevalence of paediatric inflammatory bowel disease in Sweden: A nationwide population-based register study. BMC Gastroenterol, 17(1), 23.

  16. Mcelhanon, B. O., Mccracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Pediatrics, 133(5), 872–883.

  17. Oliva-Hemker, M. M., Abadom, V., Cuffari, C., & Thompson, R. E. (2007). Nonadherence with thiopurine immunomodulator and mesalamine medications in children with Crohn disease. Journal of Pediatric Gastroenterology and Nutrition, 44(2), 180–184.

  18. Somekh, J., Peleg, M., Eran, A., et al. (2016). A model-driven methodology for exploring complex disease comorbidities applied to autism spectrum disorder and inflammatory bowel disease. Journal of Biomedical Informatics, 63, 366–378.

  19. Valicenti-Mcdermott, M. D., Mcvicar, K., Cohen, H. J., Wershil, B. K., & Shinnar, S. (2008). Gastrointestinal symptoms in children with an autism spectrum disorder and language regression. Pediatric Neurology, 39(6), 392–398.

  20. Viola, F., Civitelli, F., Di nardo, G., et al. (2009). Efficacy of adalimumab in moderate-to-severe pediatric Crohn’s disease. The American Journal of Gastroenterology, 104(10), 2566–2571.

  21. Vuong, H. E., & Hsiao, E. Y. (2017). Emerging roles for the gut microbiome in autism spectrum disorder. Biological Psychiatry, 81(5), 411–423.

  22. Walker, S. J., Fortunato, J., Gonzalez, L. G., & Krigsman, A. (2013). Identification of unique gene expression profile in children with regressive autism spectrum disorder (ASD) and ileocolitis. PLoS ONE. https://doi.org/10.1371/journal.pone.0058058.

  23. Xavier, R. J., & Podolsky, D. K. (2007). Unravelling the pathogenesis of inflammatory bowel disease. Nature, 448(7152), 427–434.

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Acknowledgments

We would like to thank Kathleen Madden, Virginia Randall, and Kirk Jensen for providing assistance with reviewing and editing this manuscript. This study was completed with support from the Congressional Directed Medical Research Programs, Autism Research Award: W81XWH-12-2-0066. This project has been presented as a poster format at DDW (Digestive Disease Week) conference in Chicago, IL on May 9, 2017.

Author Contributions

ML, JK, AS, and CMN developed study concept. ML, GHG, EHG, CREL, and CMN established study design. ML performed literature review and prepared the draft with guidance from CMN. JK and AS processed the data with analysis of data by JK and acquisition of data by AS. ML, CS, and CMN interpreted the data. All authors contributed intellectually critical revisions of the manuscript. All authors reviewed the final manuscript and gave approval for publication.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Departments of the Air Force, Army, Navy, the Department of Defense, or the U.S. Government. Several of the authors are military service members or U.S. Government employees. This work was prepared as part of their official duties under Title 17 U.S.C. 101, which defines a United States Government work as a “work prepared by a military service member or employee of the United States Government as part of that person’s official duties.” Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.”

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Correspondence to Maunoo Lee.

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Conflict of interest

Other than the funding from the Congressional Directed Medical Research Programs, Autism Research Award: W81XWH-12-2-0066, all authors denied any conflicts of interest.

Ethical Approval

The study was reviewed and approved by the Uniformed Services University Institutional Review Board.

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Lee, M., Krishnamurthy, J., Susi, A. et al. Association of Autism Spectrum Disorders and Inflammatory Bowel Disease. J Autism Dev Disord 48, 1523–1529 (2018). https://doi.org/10.1007/s10803-017-3409-5

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Keywords

  • Autism spectrum disorders (ASD)
  • Crohn’s disease (CD)
  • Ulcerative colitis (UC)
  • Inflammatory bowel disease (IBD)