Molecular markers in relation to ASD constipation (CME track/practitioner registrants only)

Problematic chronic constipation is exceedingly common in children with ASD. Our experience has been that the predominant pattern of ASD-associated constipation is characterized by the child who has infrequent stools (two or less per week) that are semi-formed or formed in texture, accompanied by fecal incontinence or anal leakage, and stool retention (evidenced on abdominal radiographs). In contradistinction to pediatric functional constipation seen in typically developing children, in which the child is voluntarily attempting to withhold stool, parents of children with ASD describe their child as making great effort to pass stool, but without success. In these children, who are often poorly or non-verbally communicative, these efforts are apparent through observation of the child who is practicing a variety of Valsalva-type maneuvers to pass stool. An unusual radiographic feature of ASD constipation is the propensity for the fecal loading to be in the cecum and ascending colon (i.e. “right-sided”), as opposed to the rectosigmoid loading seen in constipation of typically developing children.

In this talk, new data describing molecular markers indicative of this right sided fecal loading will be presented and the mechanistic features of ASD right-sided constipation that they reflect will be discussed. The significance of these findings is that they support an alternate approach to ASD constipation and an explanation as to why traditional approaches for constipation are so often ineffective.

Arthur Krigsman, MD

Dr. Arthur Krigsman is a pediatrician and pediatric gastroenterologist with internationally recognized expertise in the evaluation and treatment of autism associated gastrointestinal problems. His interest in this unique patient population began in 2001 and during the ensuing 17 years he has treated over 1900 children from across the globe suffering from autism and a variety of gastrointestinal problems. His research interest lies in the characterization of the unique cellular, molecular, and clinical features of ASD-associated inflammatory bowel disease and his original findings appear in numerous peer-reviewed journals. In addition to serving as an invited reviewer for peer-reviewed medical journal author submissions in his area of expertise, Dr. Krigsman has served as a guest lecturer on the topic of gastrointestinal disease and autism at national and international scientific meetings, hospital Grand Rounds both here and abroad, Nurse Association meetings, philanthropic organizations, and at numerous lay medical conferences. He has also presented his findings before the U.S. Congress. His greatest satisfaction though derives from the clinical care he provides his patients and in the improved quality of life that results from diagnosing and treating gastrointestinal disease in this vulnerable population. He maintains offices in both New York City and Austin, Texas.