Autism spectrum disorders and the gastrointestinal tract: insights into mechanisms and clinical relevance

Hung, L.Y., Margolis, K.G. Autism spectrum disorders and the gastrointestinal tract: insights into mechanisms and clinical relevance. Nat Rev Gastroenterol Hepatol 21, 142–163 (2024).

Abstract

Autism spectrum disorders (ASDs) are recognized as central neurodevelopmental disorders diagnosed by impairments in social interactions, communication and repetitive behaviours. The recognition of ASD as a central nervous system (CNS)-mediated neurobehavioural disorder has led most of the research in ASD to be focused on the CNS. However, gastrointestinal function is also likely to be affected owing to the neural mechanistic nature of ASD and the nervous system in the gastrointestinal tract (enteric nervous system). Thus, it is unsurprising that gastrointestinal disorders, particularly constipation, diarrhoea and abdominal pain, are highly comorbid in individuals with ASD. Gastrointestinal problems have also been repeatedly associated with increased severity of the core symptoms diagnostic of ASD and other centrally mediated comorbid conditions, including psychiatric issues, irritability, rigid–compulsive behaviours and aggression. Despite the high prevalence of gastrointestinal dysfunction in ASD and its associated behavioural comorbidities, the specific links between these two conditions have not been clearly delineated, and current data linking ASD to gastrointestinal dysfunction have not been extensively reviewed. This Review outlines the established and emerging clinical and preclinical evidence that emphasizes the gut as a novel mechanistic and potential therapeutic target for individuals with ASD.

孤独症谱系障碍（ASDs）被认为是中枢神经发育障碍，核心障碍俄日为社会互动、沟通和重复行为。对ASD是一种中枢神经系统（CNS）介导的神经行为障碍的认识，导致ASD的大多数研究集中在中枢神经系统上。然而，由于ASD的神经机制性质和胃肠道中的神经系统（肠神经系统），胃肠道功能也可能受到影响。因此，胃肠道疾病，特别是便秘、腹泻和腹痛，在ASD患者中高度共病也就不足为奇了。胃肠道问题也多次与ASD诊断的核心症状和其他中枢介导的共病条件的严重程度增加有关，包括精神问题、易怒、刚性强迫性行为和攻击性。尽管ASD中胃肠道功能障碍及其相关的行为共病的发病率很高，但这两种情况之间的具体联系尚未被明确描述，目前ASD与胃肠道功能障碍之间的联系数据尚未得到广泛的回顾。这篇综述概述了已确定的和新兴的临床、临床前证据，强调将肠道作为ASD个体的一个新的机制和潜在的治疗靶点。