Complex Gastrointestinal Issues in Autism

All contents of this resource were created for informational purposes only and are not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your physician, therapist, or other qualified health providers with any questions or concerns you may have.
Complex gastrointestinal issues in autism require more complex action. When your child is still suffering despite dietary intervention, supplementation, and remedies mentioned in the Constipation and Diarrhea article, it is time to find a qualified gastroenterologist.
When Should I Consider a GI Specialist for My Child?
Behavior is communication. If your child with autism is having frequent meltdowns, they may be due to chronic gastrointestinal pain that your child cannot express any other way.
Parents of children who have any of the following ongoing issues should consider seeing a qualified, informed pediatric gastroenterologist:
- Chronic diarrhea and/or constipation
- Distended, bloated tummies, especially after the age of two
- Stool that has an odd texture, color, and/or odor
- Undigested food that is visible in the stool
- Self-injurious behaviors or aggression towards others
- Unexplained tantrums
- Posturing behavior — applying pressure to the abdomen by leaning over an object such as the arm of the sofa, therapy ball, mom’s knee, etc.
- Some children posture in order to sleep at night
- Some children posture when trying to have a bowel movement
- Pain during the bowel movement process
- Sleep issues — difficulty falling asleep, waking during the night
- Seizures
- Not making progress in therapeutic interventions (ABA, Floortime, speech, OT, etc.)
- Weight loss or failure to grow/gain weight for more than six months
- Recurring gut imbalance (yeast, bacteria, or parasites) that does not respond to treatment
- Failure to toilet train past a reasonable age
Please note: If a symptom carries fever, long periods of irregular bowel movements, which can lead to dehydration or other issues, extreme change in behavior, or loss of sleep or appetite for an extended period of time, please contact your doctor immediately.
“Behavior is communication. Frequent meltdowns may be due to chronic gastrointestinal pain that your child cannot express any other way.”
Finding and Working with a Specialist
Not only does living with prolonged, untreated gastrointestinal issues impact a person’s overall health, it’s also painful. For this reason, we strongly recommend that all children with ongoing GI-related problems undergo a consultation and complete evaluation with a qualified, informed pediatric gastroenterologist.
Please consider the following tips for finding and working with a specialist:
- Ask fellow autism parents and friends if they have a favorite gastroenterologist who thinks outside of the box and is a good listener.
- Read our article about Finding a Doctor. Many of the tips in that article also apply to finding a specialist.
- Before your appointment, consider what you want from the gastroenterologist.
- Familiarize yourself with GI issues common to autism by reading the articles at the bottom of this page by Dr. Buie and Dr. Krigsman (two doctors who are very familiar with treating complex gastrointestinal issues in autism).
- If you bring a copy of these articles to your appointment and know what to ask for, it can make the process easier.
- Familiarize yourself with GI issues common to autism by reading the articles at the bottom of this page by Dr. Buie and Dr. Krigsman (two doctors who are very familiar with treating complex gastrointestinal issues in autism).
- During your appointment with the gastroenterologist, talk to them about recent studies linking autism and GI disorders.
- It is important to note that most gastroenterologists don’t have much experience treating GI disease in children with autism.
- Because of this, you may need to seek help well outside of your local area in order to get an appropriate evaluation and treatment plan.
What Happens During GI Assessments?

Typically, a complete assessment for a child with complex gastrointestinal issues includes the following:
- General patient intake information:
- Parent’s written narrative of child’s gastrointestinal and developmental history.
- Review of all current medical issues, including signs and symptoms you see in your child.
- Review results from any previous testing and treatment.
- Physical examination
- Depending on your child’s issues and history, the gastroenterologist may:
- Request additional lab testing (KUB, blood, urine, or stool).
- Discuss diagnostic procedures to obtain biopsies and get a better understanding of what’s triggering your child’s symptoms, specifically:
- Colonoscopy,
- Upper endoscopy (EGD), and
- Pill cam study (tiny camera in a capsule that takes photos of the small intestine).
- Request a follow-up phone consultation or appointment to review any lab results and map out a detailed treatment plan.
Complex GI Issues Common to Autism
The following is a list of complex gastrointestinal issues commonly seen among children with autism:
- Lymphoid nodular hyperplasia throughout the GI tract (swelling of lymph nodules)
- Various types of inflammation in the esophagus (usually eosinophilic; sometimes Barrett’s Esophagus)
- Gastroesophageal reflux disease (GERD)
- Various types of inflammation in the stomach (sometimes ulcers)
- Various types of inflammation in the small intestine (sometimes ulcers)
- Inflammation in the large intestine ranging from mild colitis to ulcerative colitis
- Sometimes inflammatory polyps are found in the GI tract
What Do GI Treatments Look Like?

Treatments for complex gastrointestinal issues in autism depend heavily on observations during the endoscopic procedures and the biopsy results. Common treatments for the conditions found in our children include:
- Dietary intervention:
- Gluten-free, dairy-free, and soy-free (GFCFSF); Specific Carbohydrate Diet; elemental diet, etc.
- Digestive enzymes:
- Prescription: Creon or Zenpep
- Over-the-counter: Kirkman, Houston, Enzymedica, etc.
- Probiotics
- Anti-inflammatory medications:
- Pentasa, Sulfasalazine, etc.
- Immune suppressing or modulating medications to address inflammation (which is often autoimmune):
- Prednisolone, Entocort, Rhinocort, Nasonex, etc.
- Acid suppressing medications, like Prevacid, to address gastroesophageal reflux disease (heartburn).
Common Questions Concerning Endoscopic Procedures

If your child is suffering from complex gastrointestinal issues, their gastroenterologist may need to perform an endoscopy to examine their digestive tract and obtain biopsies for lab testing. The following are answers to some frequently asked questions about endoscopic procedures.
Resources
- Gastrointestinal Pathology in Autism: Description and Treatment
- Dr. Krigsman wrote this article in 2007 for parents to describe the GI conditions commonly found in our kids and possible treatments.
- Evaluation, Diagnosis and Treatment of Gastrointestinal Disorders in Individuals with Autism Spectrum Disorders: A Consensus Report,
- The lead author is Dr. Timothy Buie.
- 2010 consensus report consisting of 23 statements to help guide physicians in evaluating and treating the gastrointestinal issues in individuals with ASD.