PC1004: Medical Management of Constipation in Autism Spectrum Disorder as It Relates to the Transition to Adulthood

Background: Gastrointestinal symptoms, with constipation being the most common, have been shown to be highly associated with Autism Spectrum Disorder (ASD) and its core symptoms. For this reason, the optimal management of constipation in this population has become a great focus in the overall care of these individuals. However, the approach by which constipation is managed in this population over time as they undergo the transition to adult care has remained unexamined.

Methods: This is a retrospective cohort study that examines patients ages 2-65 years with a diagnosis of ASD in a large integrated healthcare system and their overall healthcare utilization in the form of hospitalizations, emergency department (ED) visits, and office visits over a five-year period (1/1/2015-12/31/2019). Medication management for constipation was also examined as it related to age during this same period. Specifically, the number and types of anti-constipation medications prescribed were noted. SAS 15.1 was used for descriptive statistical and multivariant regression analysis.

Results: Of 4,082 patients included in the study, 25.9% (n=1059) of patients had anti-constipation medications prescribed during the study period. Among patients prescribed these medications, there was an increase in hospitalizations and ED visits in the 6-9 year and 19-24 year age ranges (p < 0.05). When examining the prescription patterns of these medications, there was a noted increase in anti-constipation prescriptions for every decade above 20 years of age compared to the previous decade (p < 0.01). Newer medications like linacolotide and lubiprostone showed an increase in prescription for patients between 14-28 years old and those older than 50 years old. Lactulose had a linear decrease in prescriptions for patients 5-12 years old but then a sharp rise after 23 years old. Polyethylene glycol 3350 being the most commonly prescribed medication, had the highest proportion of use in the 5-14 year age range. When agents were divided among subclasses, those above 18 years of age had increased prescription of stimulants, surfactant and saline laxatives as well as increased diversity of prescription classes (p < 0.01). Primary care providers (pediatrics, family medicine, internal medicine) were the main specialty prescribing anti-constipation medications for patients older than 15 years of age, while pediatric gastroenterology was the dominating prescribing specialty (43.4%) for those younger than 15 years old.

Conclusion: There appears to be a change in the approach to constipation management in patients with ASD as they undergo the transition into adulthood. Not only does this study demonstrate there to be a change in the diversity of agents prescribed to treat constipation in these patients during this transition, but there also appears to be a change in the providers involved in this management as well as overall healthcare utilization during this time as well.