GER in 6 autistic children: Buie 2005

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GASTROESOPHAGEAL REFLUX IN CHILDREN WITH AUTISM: HOW DO CHILDREN PRESENT

AND CAN ONE TEST THESE CHILDREN?

M. Buie. Pediatric GI, MGH, Boston, MA.

Journal of Pediatric Gastroenterology and Nutrition 2005 41:493--563

Background: Gastroesophageal Reflux (GER) is primarily diagnosed

by

symptom description. Children with autism have core difficulty commu-

nicating and atypical social relatedness. For this reason, identification of

GER in autistic children may be difficult. The prevalence of GER in

autism remains unknown, but several reports identify esophagitis as a

finding in autistic children undergoing endoscopy.

Aims: To evaluate autistic children with GI complaints and aggression

or self-injurious behavior in order to determine if these behaviors may

be symptoms of GER.

Methods: Six consecutive autistic children (ages 8--19 years) under-

going endoscopy and scheduled for BRAVO (wireless) pH probe were

evaluated for histology and pH meter results.

Findings: GER was identified in 5 of 5 patients tested by BRAVO pH

testing. Esophagitis was seen in 3 of 6 patients biopsied. See tables below.

Conclusions:

1. Gastroesophageal reflux can be tested in children with autism using

wireless BRAVO pH probe technology.

2. Aggresive or self-injurious behavior may be a manifestation of pain

from GER and should prompt consideration of further investigation.

3. Further study of non-classic GI symptoms needs to be considered in

children with autism.

TABLE 1. Demographics and symptoms

Patient Age, yrs Symptoms at presentation

AS 8 History of GER, regurgitation, Chest pain,

Sleep disturbance, Aggressive behavior,

Self-injurious behavior (SIB)

JG 11 History of GER, Pressing on chest,

Aggressive behavior, Unexplained crying

JB 19 Posturing episodes, Eructation

CR 10 Posturing episodes, Eructation

ND 13 Apparent pain, Aggressive behavior

RS 10 Aggressive behavior, SIB

TABLE 2. Findings: Endoscopic histology and

pH probe results

Patient

Endoscopic

histology

findings

pH probe

results Day 1

(DeMeester score)

pH probe

results Day 2

(DeMeester score

AS Acute Esophagitis 75.1 50.8

JG Normal Histology 34.8 21.9

JB Acute Severe

Erosive

Esophagitis

42.5 37.6

CR Normal Histology 19.7 23.1

ND Normal Histology 22.7 7.9

RS Acute Severe

Erosive

..