Children with autism spectrum disorder and alterations in eating behavior - could it be gastroesophageal reflux disease?

Sep 30, 2026

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Objective: describe warning signs of gastroesophageal reflux disease (GERD) and esophagitis in children with autism spectrum disorder (ASD) who show alterations in eating behavior (EB). Method: descriptive study of 115 children aged 3–12, assessed with BRCA-TEA for EB alterations and 17-ATN-GISSI for GERD warning signs; suspected esophagitis led to medical consultation and upper GI endoscopy with biopsies. Results: 60% had EB alterations and 89.8% of these showed GERD warning signs; 8 were examined and 3 had erosive esophagitis (grades A/B) plus eosinophilic esophagitis. Conclusion: EB alterations and GERD warning signs are frequent in ASD; endoscopy with biopsies is essential for diagnosis when esophagitis is suspected.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Introduction

Jornal de Pediatria 2026;102(1): 101487 [www.jped.com.br](www.jped.com.br) ORIGINAL ARTICLE Children with autism spectrum disorder and alterationsin eating behavior: could it be gastroesophageal reﬂux disease? Christine Audet de Almeida a,b,* , Eduardo Sampaio Siqueira a, Marcelo do Rego Maciel Souto Maior a,d, Ktia Gale~ao Brandt a,b,c a Universidade Federal de Pernambuco (UFPE), Hospital das Clinicas, Recife, PE, Brazil b Ps Graduac¸~ao em Sade da Crianc¸a e do Adolescente da Universidade Federal de Pernambuco, PE, Brazil c Centro de Ci^encias Mdicas da Universidade Federal de Pernambuco, PE, Brazil d Ps Graduac¸~ao em Nutric¸~ao da Universidade Federal de Pernambuco, PE, Brazil Received 17 July 2025; accepted 31 October 2025 Available online xxx KEYWORDSEating behavior; Autism; Autism spectrum disorder; Child; Gastroesophageal reﬂux disease Abstract Objective: Describe the occurrence of warning signs of gastroesophageal reﬂux disease (GERD) and esophagitis in children with eating behavior (EB) alterations associated with autism spectrum disorder (ASD) . Method: Descriptive study of 115 children aged 3 to 12 years, followed at a tertiary hospital and previously diagnosed with ASD. The BRCA-TEA instrument was applied to identify children with EB alterations, and the 17-ATN-GISSI instrument was applied to identify those with warning signs of GERD. The selected children were invited for a medical consultation to identify those with suspected esophagitis and an indication for upper gastrointestinal (GI) endoscopy with biopsies. Results: Sixty-nine children (60 %) were classiﬁed with alterations in the EB and, among these, 62 (89.8 %) presented warning signs of GERD. Eighteen children had suspected esophagitis and an indication for upper GI endoscopy. Among the 8 children who underwent the exam, 1 child had grade A erosive esophagitis, 1 child had grade B erosive esophagitis, and 1 child had eosinophilic esophagitis. Conclusion: A high frequency of EB alterations was found in children with ASD. The high frequency of GERD warning signs may be related to EB alterations in this group. Cases of esophagitis highlight the possibility of an organic disease. In these cases, performing upper GI endoscopy with biopsies is essential for diagnosis. © 2025 The Authors. Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Pediatria. This is an open access article under the CC BY license ([http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/) ) . * Corresponding author. E-mail: [christineaudet@uol.com.br](christineaudet@uol.com.br) (C.A. de Almeida). [https://doi.org/10.1016/j.jped.2025.101487](https://doi.org/10.1016/j.jped.2025.101487) 0021-7557/© 2025 The Authors. Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Pediatria. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). Introduction Eating is a necessary act for our survival, providing great pleasure, but it can also be disrupted by numerous factors. Eating habits in children are partially based on biological factors, but subject to environmental inﬂuences that can change or develop with age.1 Children with ASD have a high prevalence of alterations in EB, ranging from 49 % to 90 % .2 Alterations in EB in this group are usually associated with behavioral causes and are attributed to characteristics common to ASD, such as rigid and repetitive patterns of behavior, oral sensory difﬁculties, and impairment in social skills.3,4 Although behavioral causes are often given more importance in the literature, children with ASD also have a greater chance of developing gastrointestinal (GI) disorders and diseases, such as GERD and esophagitis, possibly explained by changes in the regulation of the brain-gut axis.5 There is also evidence th

FAQs

What was the study’s main objective regarding ASD and eating behavior?

To describe the occurrence of GERD warning signs and esophagitis in children with ASD who have eating behavior (EB) alterations.

How were eating behavior alterations and GERD warning signs identified?

EB alterations were identified using the BRCA-TEA instrument, and GERD warning signs were identified using the 17-ATN-GISSI instrument.

What did endoscopy and biopsies show in children with suspected esophagitis?

Among 8 examined children, findings included grade A erosive esophagitis, grade B erosive esophagitis, and eosinophilic esophagitis.

Sep 30, 2026

Uploaded by Finn