Afzal Nadeem, Murch Simon, Thirrupathy Kumran, Berger Leslie, Fagbemi Andrew, Heuschkel Robert
Centre for Pediatric Gastroenterology, Royal Free Hospital, Hampstead, London, United Kingdom.
Pediatrics. 2003 Oct;112(4):939-42. doi: 10.1542/peds.112.4.939.
Recent evidence suggests that autistic children may have significant gastrointestinal symptoms. Although constipation occurs in 2% to 5% of healthy children, its clinical diagnosis is often difficult in children with behavioral disorders. We thus aimed to assess the prevalence of fecal loading in autistic children with gastrointestinal symptoms and to identify possible predictors of constipation.
We studied abdominal radiographs of 103 autistic children (87 boys) who were referred for gastroenterological assessment, in comparison with 29 control radiographs from children who were referred to the emergency department, most with abdominal pain. Radiographs were scored independently, in blinded manner, by 4 pediatric gastroenterologists and a radiologist. The severity of constipation was determined using a validated index. Details of stool habit, abdominal pain, dietary history, and laxative use were obtained from case notes.
The incidence of constipation in the control subjects with abdominal pain was higher than reported for normal children. Despite this, moderate or severe constipation was more frequent in the autistic group than in the control subjects (36% vs 10%). Analysis of rectosigmoid loading showed more striking differences (54.4% of autistic children had moderate/severe loading or acquired megarectum compared with 24.1% of control subjects). Multivariate regression analysis showed consumption of milk to be the strongest predictor of constipation in the autistic group, whereas stool frequency, gluten consumption, soiling, and abdominal pain were not predictive of constipation.
Constipation is a frequent finding in children with gastrointestinal symptoms and autism, particularly in the rectosigmoid colon, often with acquired megarectum. The absence of any correlation between the clinical history and the degree of fecal impaction in autistic children confirms the importance of an abdominal radiograph in the assessment of their degree of constipation.
近期证据表明，自闭症儿童可能有明显的胃肠道症状。虽然便秘在2%至5%的健康儿童中出现，但对于有行为障碍的儿童，其临床诊断往往困难。因此，我们旨在评估有胃肠道症状的自闭症儿童中粪便嵌塞的患病率，并确定便秘的可能预测因素。
我们研究了103名因胃肠病评估而转诊的自闭症儿童（87名男孩）的腹部X光片，并与29名因腹痛转诊至急诊科的儿童的对照X光片进行比较。4名儿科胃肠病学家和1名放射科医生以盲法独立对X光片进行评分。使用经过验证的指数确定便秘的严重程度。从病例记录中获取大便习惯、腹痛、饮食史和泻药使用的详细信息。
有腹痛的对照受试者中便秘的发生率高于正常儿童的报告发生率。尽管如此，自闭症组中中度或重度便秘比对照受试者更常见（36%对10%）。直肠乙状结肠负荷分析显示出更显著的差异（54.4%的自闭症儿童有中度/重度负荷或获得性巨直肠，而对照受试者为24.1%）。多变量回归分析显示，牛奶摄入是自闭症组便秘的最强预测因素，而大便频率、麸质摄入、弄脏和腹痛不是便秘的预测因素。
便秘在有胃肠道症状和自闭症的儿童中很常见，特别是在直肠乙状结肠，常伴有获得性巨直肠。自闭症儿童的临床病史与粪便嵌塞程度之间无任何相关性，这证实了腹部X光片在评估其便秘程度中的重要性。
