Screen for and manage GERD
Screen annually for GERD or when symptoms or signs are detected. Manage GERD. If introducing medications (eg, NSAIDs) that might aggravate GERD, monitor for onset of GERD symptoms.168
Strongly Recommended
Empirical Ecosystem Expert
Gastrointestinal problems are common among people with IDD and are manifested by food aversions, changes in behaviour, or weight loss.167-172
Assess for common issues
If unexplained weight, gastrointestinal, or behavioural changes are detected, assess for common issues (eg, constipation, GERD, peptic ulcer disease, celiac disease, and pica).169, 173-175
Strongly Recommended
Empirical Ecosystem Expert
Gastrointestinal problems are common among people with IDD and are manifested by food aversions, changes in behaviour, or weight loss.167-172
Test for Helicobacter pylori infection
Test for Helicobacter pylori infection in symptomatic patients or asymptomatic patients who live or have lived in a group residence.178 Retest at regular intervals (eg, 3-5 y).179
Recommended
Empirical Expert
People with IDD are at an increased risk of acquiring Helicobacter pylori infection if they have ever lived in group-living settings.176, 177
Ask about bowel movements
Ask about frequency and consistency of bowel movements regularly to detect constipation (eg, using the Bristol Stool Chart) and address reversible medical causes.173
Recommended
Empirical Expert
People with IDD frequently experience constipation related to neurological dysfunction, lack of physical activity, a low-fibre diet, or medications with anticholinergic effects, which can lead to significant morbidity. Pain associated with constipation may present as distress, sleep disturbance, or behavioural changes including self-harm.169, 173, 180, 181
Use bowel monitoring charts
For patients with constipation or diarrhea, use a Bowel Movement Monitoring Chart 182 that patients and caregivers can complete.
Recommended
Empirical Expert
People with IDD frequently experience constipation related to neurological dysfunction, lack of physical activity, a low-fibre diet, or medications with anticholinergic effects, which can lead to significant morbidity. Pain associated with constipation may present as distress, sleep disturbance, or behavioural changes including self-harm.169, 173, 180, 181
Bowel Movement Monitoring Chart
The Bowel Movement Monitoring Chart, developed by the Developmental Disabilities Primary Care Initiative at Surrey Place (Toronto, 2011), can be used to monitor bowel movement over time.
Bristol Stool Chart
The Bristol Stool Chart developed by Dr. Kenneth W Heaton and Dr. Stephen J Lewis (1997) provides a descriptive classification of stool consistency. Available at the Registered Nurses’ Association of Ontario website.
167. Atay O. Chapter 100: Gastrointestinal issues. In: Rubin IL, Merrick J, Greydanus DE, Patel DR, editors. Health care for people with intellectual and developmental disabilities across the lifespan. Rubin and Crocker 3rd ed. Springer; 2016. p. 1209-24.
168. Bohmer CJ, Klinkenberg-Knol EC, Niezen-de Boer, Meuwissen SG. Gastroesophageal reflux disease in intellectually disabled individuals: How often, how serious, how manageable? Am J Gastroenterol. 2000;95(8):1868-72.
169. Bohmer CJ, Taminiau JA, Klinkenberg-Knol EC, Meuwissen SG. The prevalence of constipation in institutionalized people with intellectual disability. J Intellect Disabil Res. 2001;45(3):212-8.
170. Kozlowski AM, Taylor T, Gonzalez ML, Girolami PA. Chapter 5: Feeding disorders. In: Matson JL, Matson ML, editors. Comorbid conditions in individuals with intellectual disabilities. Dordrecht, Switzerland: Springer; 2015. p. 109-43.
171. Tracy JM, Wallace R. Presentations of physical illness in people with developmental disability: The example of gastro-oesophageal reflux. Med J Aust. 2001;175(2):109-11.
172. Morad M, Nelson NP, Merrick J, Davidson PW, Carmeli E. Prevalence and risk factors of constipation in adults with intellectual disability in residential care centers in israel. Res Dev Disabil. 2007;28(6):580-6.
173. Coleman J, Spurling G. Constipation in people with learning disability. BMJ. 2010;340:c222.
174. Mishori R, McHale C. Pica: An age-old eating disorder that’s often missed. J Fam Pract. 2014;63(7):E1-4.
175. Williams DE, McAdam D. Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners. Res Dev Disabil. 2012;33(6):2050-7.
176. Kitchens DH, Binkley CJ, Wallace DL, Darling D. Helicobacter pylori infection in people who are intellectually and developmentally disabled: A review. Spec Care Dent. 2007;27(4):127-33.
177. Duff M, Scheepers M, Cooper M, Hoghton M, Baddeley P. Helicobacter pylori: Has the killer escaped from the institution? A possible cause of increased stomach cancer in a population with intellectual disability. J Intellect Disabil Res. 2001;45(Pt 3):219-25.
178. Wallace R, Schluter PJ, Duff M, Ouellette-Kuntz H, Webb PMSM. A review of the risk factors for, consequences, diagnosis, and management of helicobacter pylori in adults with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities. 2004;1(3-4):147-63.
179. Wallace RA, Schluter PJ, Webb PM. Recurrence of helicobacter pylori infection in adults with intellectual disability. Intern Med J. 2004;34(3):132-3.
180. Cockburn-Wells H. Managing constipation in adults with severe learning disabilities. Learning Disability Practice. 2014;17(9):16-22.
181. Vande Velde S, Van Biervliet S, Van Goethem G, De Looze D, Van Winckel M. Colonic transit time in mentally retarded persons. Int J Colorectal Dis. 2010;25(7):867-71.
182. DDPCI Developmental Disabilities Primary Care Initiative. Bowel movement (B.M.) – monthly monitoring record (for people who have bowel problems). In: Tools for caregivers: Monitoring charts. Toronto, Canada: Surrey Place; 2013.
