Secretin and Autism Ranking:

Syringe Secretin is a gastrointestinal hormone that helps to promote digestion of food.

It stimulates the stomach to produce the enzyme pepsin, the liver to produce bile, and the pancreas to produce digestive juices that help neutralize acidity in the intestines.

The main medical use of secretin is as a diagnostic tool in various disorders of the pancreas (such as gastrinoma).

Some people believe that secretin can be used to treat gastrointestinal problems (such as constipation and diarrhoea) in autistic people. They also believe that treating those gastrointestinal problems will lead to improvements in other areas (such as sociability, speech, and sleep).

Please Note

The National Institute of Health and Clinical Excellence (NICE) made the following recommendation.

'Do not use secretin for the management of core symptoms of autism in adults.' (NICE, 2012)

Our Opinion

There is a reasonable amount of research evidence (17 group studies and four single-case design studies) into the use of secretin for autistic individuals.

The vast majority of those studies reported no benefits of any kind and some reported adverse effects (such as an increase in challenging behaviours).

A minority of lower quality studies reported a range of benefits (such as improved gastrointestinal symptoms, alongside improved eye contact and alertness) in a sub-group of participants. However those benefits failed to reach statistical significance, meaning that they could have happened as the result of chance.

There is evidence from a range of sources to suggest that secretin may sometimes cause potentially harmful effects.

We believe that the theory behind the use of secretin as a treatment for autistic people is weak and unproven. We also believe that the research evidence suggests that secretin provides no real benefits for autistic people.

Because of this we cannot recommend the use of secretin for autistic people.

Disclaimer

Please read our Disclaimer on Autism Interventions

Audience

Some people believe that secretin may be an appropriate treatment for anyone autistic who has one or more gastrointestinal problems (such as constipation or diarrhoea).

Aims and Claims

Aims

The main medical use of secretin is as a diagnostic tool in various disorders of the pancreas. However some people believe that secretin can be used to treat gastrointestinal problems (such as constipation and diarrhoea) in autistic people. They also believe that treating those gastrointestinal problems will lead to improvements in other areas (such as sociability, speech, and sleep).

Claims

There have been various claims made for the use of secretin as an intervention for autistic people. For example,

Horvath et al (1998) claimed “significant amelioration of the children was observed, as was a dramatic improvement in their behavior, manifested by improved eye contact, alertness, and expansion of expressive language”
Lonsdale and Shamberger (2000) claimed that approximately half of the participants treated in their study showed “minor to major behavioral and/or bowel function improvement”.
Robinson (2001) claimed that approximately half of the participants treated in his study improved in one way or another (such as being more relaxed, being more communicative or being less aggressive).

Key Features

Secretin is a gastrointestinal hormone that helps to promote digestion of food.

It stimulates the stomach to produce the enzyme pepsin, the liver to produce bile, and the pancreas to produce digestive juices that help neutralize acidity in the intestines.

The main medical use of secretin is as a diagnostic tool in various disorders of the pancreas (such as gastrinoma). However, according to the WebMD website accessed on 15 May 2018, it is also sometimes used to treat conditions such as an overactive parathyroid gland, duodenal ulcers, bleeding in the stomach and intestines, and heart failure.

Secretin is normally injected subcutaneously into the fat layer between the skin and muscle. However it is occasionally administered in other ways.

Transdermal: cream or ointment that is rubbed into the skin.
Ingestion: homeopathic solution or tablet that is swallowed.

Medications containing secretin are sold under a variety of brand names in different countries including ChiRhoStim, Secretin-Ferring, SecreFlo and Secrelux.

Each of these brands may be available in different dosages. For example, ChiRhoStim is available as 16mcg/vial and 40mcg/vial of powder that is mixed with a sodium chloride solution prior to injection.

The correct dosage of secretin will depend on the nature of the condition being treated, the body weight of the patient, the brand of secretin being used and the way that is administered.

Notes

Bile (secretion produced by the liver which aids in the digestion of fats in the duodenum); Duodenum (first and shortest segment of the small intestine); Gastrinoma (rare type of tumour that usually develops in the digestive system); Pancreas (gland which forms part of the digestive system); Parathyroid glands (glands in the neck that control the body's calcium levels); Pepsin (digestive enzyme that breaks down proteins).

Cost and Time

Cost

The cost of using secretin will depend on a number of factors including the supplier, the form of secretin, the brand, the dosage, and the length and frequency of treatment.

It is now possible to obtain secretin at roughly the same rates as some other medications. For example, we found one supplier providing secretin in a dose of 250 UG for $250 when we did an internet search on 18 May 2018. This is considerably cheaper than in the early 2000’s when some parents in the USA were paying up to $10,000 a year to obtain supplies from overseas – according to the New York Times website, accessed on 18 May 2018.

Time

The amount of time it takes to use secretin will depend on a number of factors including the overall length of treatment, the frequency of treatments and the time taken to administer a single dose, as well as the needs of the person undertaking it.

Secretin is normally only injected once but in some of the studies we looked at the participants were injected two or three times several weeks apart. In one of the other studies, an ointment containing secretin was applied to the skin daily for four weeks. In another study, a homeopathic infusion of secretin was taken twice a day for 12 weeks.

Risks and Safety

Hazards

Secretin is a powerful hormone and can produce powerful side-effects. For example,

According to the WebMD website, accessed on 15 May 2018,

“Common side effects of secretin include flushing of the face, neck, and chest immediately after a dose. Less common side effects are vomiting, diarrhea, fainting, blood clot, fever, and rapid heartbeat. Some people can have allergic reactions including hives, redness of the skin, and a life-threatening allergic reaction (anaphylaxis).”

According to the Drugs.Com website, accessed on 15 May 2018,

“Gastrointestinal side effects have included nausea, abdominal pain, vomiting, mild pancreatitis, upset stomach, burning in stomach or abdomen, diarrhea, and a warm sensation in the abdomen.” “Cardiovascular side effects have included increased heart rate, faintness, hypotension, and slow heart rate (57 bpm).” “Nervous system side effects have included headache, anxiety, numbness or tingling in extremities, possible seizure, and sedation.” “General side effects have included diaphoresis, clammy skin, increased oral secretions, and a warm sensation in the face.” “Respiratory side effects have included transient low O2 saturation and transient respiratory distress.” “Dermatologic side effects have included abdominal rash.”

Contraindications

There are some contraindications (something which makes a particular treatment or procedure potentially inadvisable) for secretin.

For example,

According to the Drugs.Com website, accessed on 15 May 2018, “A total of 52 drugs (362 brand and generic names) are known to interact with ChiRhoStim (secretin)”. This might make it inadvisable to use secretin in individuals who are using one or more of those other drugs.
According to the WebMD website, accessed on 15 May 2018, the following conditions are contraindicated for secretin: alcoholism, asthma and liver problems.

Notes

Diaphoresis (excessive sweating); Hypotension (low blood pressure); O2 saturation (level of oxygen in the blood); Respiratory distress (breathing difficulties).

Suppliers and Availability

Secretin is a powerful hormone with many potential side effects and contraindications. For this reason it should only be obtained on prescription from an appropriately qualified health care professional. In practice, secretin is normally only sold to qualified health care providers or researchers.

History

Secretin was discovered in 1902 by physiologists William Maddock Bayliss and Ernest Starling. Its use as a treatment for autism was discovered by chance in 1998.

A young autistic boy, Parker Beck, was given secretin at the same time as he was given an endoscopy to find out what was causing his severe diarrhoea. He appeared to make remarkable improvements, smiling and talking for the first time. His parents believe that secretin was the cause of those improvements.

The first published study (Horvath et al, 1998) described the use of secretin in three autistic children. The study reported that the children reduced autism-related symptoms after receiving secretin as part of gastrointestinal testing. This trial was reported widely, leading many parents to request the use of secretin for their autistic children.

Since then many clinical trials have been undertaken, the vast majority of which have shown that secretin does not provide any benefits to autistic people.

Current Research

Description of Studies

We have identified 21* articles published in English-language, peer-reviewed journals which evaluated the efficacy of secretin as an intervention for autistic people. One of those articles (Honomichl et al, 2002) was a follow up study using the participants from two of the other studies.

The articles we identified included more than seven hundred autistic individuals aged from two years to 42 years old, although the bulk of studies were of primary school-age children. Individuals with specific diagnoses included people with autistic disorder or pervasive developmental disorder - not otherwise specified.

In most cases, the participants received a single injection of secretin and/or a single injection of a placebo (usually a saline solution). In some cases, the participants received two or three injections of secretin and/or a placebo, each dose separated by several weeks.

The majority of participants who were injected received doses of 2 CU per KG of their body weight, although a minority received doses of 3 or 4 CU per KG of their body weight.

In one study, the participants were treated with an ointment containing secretin once-daily over four weeks. In one study, the participants received a homeopathic dose of secretin twice-daily over a period of 12 weeks.

In 10 studies, the participants received porcine secretin (derived from pigs) and in six studies the participants received synthetic human secretin. In one of these studies, porcine secretin was compared to synthetic human secretin. In the remaining studies, the type of secretin was not specified.

16 of the studies used a randomised controlled design (comparing secretin with something else) and four of the studies used a single-case design (not comparing secretin with anything else). 11 of the randomised controlled studies used a crossover design (where each participant received both secretin and placebo but at different times).

Outcomes of Studies

17 of the studies reported that secretin produced no benefits or produced short-term effects that were no different to the effects produced by a placebo.
Five of the studies reported limited or mixed results. For example, the study by Kern et al (2002) reported that there were no significant differences between the secretin group and the placebo group on most outcome measures.
Those five studies did report that there was a subgroup of participants with gastrointestinal problems who appeared to improve on measures such as irritability, agitation and crying when given secretin. However those benefits failed to reach statistical significance, meaning that they could have happened as the result of chance.
Only one of the studies (Horvath et al, 1998) reported positive benefits of secretin with no qualifications. The study recorded that “significant amelioration of the children was observed, as was a dramatic improvement in their behavior, manifested by improved eye contact, alertness, and expansion of expressive language.”
A number of the studies reported adverse effects. For example one study (Kern et al, 2002) reported that one boy became much worse after receiving the secretin “according to his parents (e.g., tantrums, not following instructions, screaming, hyperactive, and aggression).”

Status Research

There are a number of limitations to all of the research studies published to date. It is worth noting that the study by Horvath et al, 1998 which initiated the huge interest in secretin, was a particularly poor study.

Type of study

Four of the studies (Horvath et al, 1998, Lightdale et al, 2001; Lonsdale and Shamberger, 2000; Robinson 2001) used single-case designs, that is, they did not have a control group of participants who did not receive the intervention
The study by Horvath et al, 1998 was a retrospective case series which used no form of experimental control. This is an especially weak design.
Some of the randomised controlled studies did not appear to follow or report all of the protocols expected within randomised controlled studies. For example, the study by Chez et al, 2000 did not adequately explain how the participants were randomised to the different groups. The study by Sandler et al, 1999 did not provide sufficient details about the allocation concealment (the way in which the participants and researchers were kept blind as to which participant received which intervention). The study by Carey et al, 2000 provided insufficient outcome data.

Participants

One of the single case designs (Horvath et al, 1998) included only three children. It also only included children with specific symptoms (diarrhoea) who had been admitted to hospital for a specific medical procedure (a gastrointestinal endoscopy).
Seven of the group studies included fewer than 30 participants and three of these group studies (Carey et al, 2002; Handen et al, 2005; Sponheim et al, 2002) included fewer than 10 participants.
One of the studies (Lonsdale, 2000) had a very high dropout rate, with 16 participants (25% of the total) not completing the study.
Some of the studies were restricted to specific groups of participants. For example, the study by Owley et al (2001) looked only at children diagnosed with autistic disorder rather than at adolescents or at children diagnosed with other forms of autism.

Intervention/s

Some of the studies did not provide enough details about the experimental intervention. For example, Lonsdale and Shamberger, 2000 stated that the participants received a single vial of secretin but they did not state what type of secretin was used and they did not state the dosage in the vial.
Most of the studies used a single dose of secretin and/or a single dose of the placebo - although this was in line with the anecdotal claims for how secretin is supposed to work.
Most of the studies which used more than one dose of secretin ran for relatively short periods of time (four to eight weeks).
Some of the studies (such as Chez et al, 2000) examined many participants who were receiving other medications or other forms of intervention at the same time as they received the secretin.
Some of the cross-over trials had relatively short wash-out periods between interventions (one or two weeks) but one cross-over trial (Sponheim et al, 2002) had no wash-out period at all between interventions.
The infusion of secretin in the study by Horvath et al (1998) took place alongside an endoscopy delivered under full anaesthetic which could have influenced the outcome of the study.

Comparators

Many of the studies compared an experimental group (who received the secretin) with an experimental group (who received the placebo). However, in some studies, the participants in the experimental group were different to the participants in the control group. For example, in the study by Coniglio et al, 2001, the children in the experimental group had lower total language-age scores at intake than the children in the control group.

Outcomes

The study by Horvath et al (1998) had a number of significant flaws in terms of how it reported the outcomes. For example only two of the three participants were assessed using standardised outcomes measures; outcome (and baseline) data were not provided from any of those standard measures; the study did not provide any data within table 3, which supposedly reported on changes in the core features of autism; the study combined data from a range of sources in table 4 but did not state which, making it impossible to assess that data or compare it with other studies
Some of the studies did not provide enough detail about the outcomes for us to be able to make a considered assessment. For example, the study by Lonsdale, 2002 reported that there were 39 participants whose “clinical response varied from minor to major behavioral and/or bowel function improvement”. However the study did not provide any details on what those behavioural or bowel function improvements were.
Some of the studies used a small number of outcome measures. For example, Carey et al (2002) used only one outcome measure, the Aberrant Behavior Checklist.
Other studies did not use standardised, widely accepted outcome measures. For example, the study by Lonsdale and Shamberger, 2000 used only one behavioural outcome measure, which was a highly subjective, non-validated form on which the parents were asked to survey each of the listed symptoms and apply a numerical score on a weekly basis throughout the period of surveillance.
Most of the studies did not use a standardised measure of adverse effects (such as the Treatment Emergent Symptoms Scale) and some of the studies (Lightdale et al 2001) did not report whether there were any adverse side effects.
Most of the studies did not identify if secretin had any beneficial effects in the medium to long term (six months or longer). For example, Corbett et al, 2001 carried out a single assessment of the outcomes and did so only one week after administration of the secretin.

Other

Very few of the studies appeared to involve autistic people and parents and carers in the design, development and evaluation of those studies.

For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’

Future Research

Summary of Existing Research

There is a reasonable amount of research evidence (17 group studies and four single-case design studies with three or more participants) into the use of secretin for autistic people.

The vast majority of those studies reported no benefits of any kind and some reported adverse effects (such as an increase in challenging behaviours).

There is evidence from a range of sources to suggest that secretin may sometimes cause potentially harmful effects.

Recommendations for Future Research

There is already sufficient research evidence to suggest that secretin is ineffective as an intervention for autistic people. There is therefore no reason to carry out further studies.

Studies and Trials

This section provides details of scientific studies into the effectiveness of this intervention for people with autism which have been published in English-language, peer-reviewed journals.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials

Carey T. et al. (2002) Double-blind placebo-controlled trial of secretin: effects on aberrant behavior in children with autism. Journal of Autism and Developmental Disorders. 32(3), Read Abstract (New Window)
Chez M. G. et al. (2000) Secretin and autism: a two-part clinical investigation. Journal of Autism and Developmental Disorders. 30(2), Read Abstract (New Window)
Coniglio S. J. et al. (2001) A randomized, double-blind, placebo-controlled trial of single-dose intravenous secretin as treatment for children with autism. Journal of Pediatrics. 138(5),
Coplan J. et al. (2003) Children with autistic spectrum disorders. II: Parents are unable to distinguish secretin from placebo under double-blind conditions. Archives of Disease in Childhood. 88(9), Read Full (New Window)
Corbett B. A., Khan K., Czapansky-Beilman D. (2001) A double-blind, placebo-controlled crossover study investigating the effect of porcine secretin in children with autism. Clinical Pediatrics. 40(6), Read Abstract (New Window)
Dunn-Geier J. et al. (2000) Effect of secretin on children with autism: a randomized controlled trial. Developmental Medicine and Child Neurology. 42(12), Read Abstract (New Window)
Handen B. L., Hofkosh D. (2005) Secretin in children with autistic disorder: A double-blind, placebo-controlled trial. Journal of Developmental and Physical Disabilities. 17(2), Read Abstract (New Window)
Honomichl R. D. et al. (2002) Secretin and sleep in children with autism. Child Psychiatry and Human Development. 33(2), Read Full (New Window)
Horvath K. et al. (1998) Improved social and language skills after secretin administration in patients with autistic spectrum disorders. Journal of the Association for Academic Minority Physicians. 9(1), Read Abstract (New Window)
Kern J. K. et al. (2002) Efficacy of porcine secretin in children with autism and pervasive developmental disorder. Journal of Autism and Developmental Disorders. 32(3), Read Abstract (New Window)
Levy S. E. et al. (2003) Children with autistic spectrum disorders. I: comparison of placebo and single dose of human synthetic secretin. Archives of Disease in Childhood. 88(8), Read Full (New Window)
Lightdale J. R. et al. (2001) Effects of intravenous secretin on language and behavior of children with autism and gastrointestinal symptoms: a single-blinded, open-label pilot study. Pediatrics. 108(5), Read Abstract (New Window)
Ratliff-Schaub K. et al. (2005) Randomized controlled trial of transdermal secretin on behavior of children with autism. Autism. 9(3), Read Abstract (New Window)
Roberts W. et al. (2001) Repeated doses of porcine secretin in the treatment of autism: a randomized, placebo-controlled trial. Pediatrics. 107(5), Read Abstract (New Window) Read Full (New Window)
Robinson T. (2001) Homeopathic secretin in autism: a clinical pilot study. British Homeopathic Journal. 90(2), Read Abstract (New Window)
Sandler A. D. et al. (1999) Lack of benefit of a single dose of synthetic human secretin in the treatment of autism and pervasive developmental disorder. New England Journal of Medicine. 341(24), Read Abstract (New Window) Read Full (New Window)
Sponheim E., Oftedal G., Helverschou S. B. (2002) Multiple doses of secretin in the treatment of autism: a controlled study. Acta Paediatrica. 91(5), Read Abstract (New Window)
Unis A. et al. (2002) A randomized, double-blind, placebo-controlled trial of porcine versus synthetic secretin for reducing symptoms of autism. Journal of the American Academy of Child and Adolescent Psychiatry. 41(11), Read Abstract (New Window)

Additional Information

The Cochrane Review of secretin and autism (Reichow et al, 2012) identified and evaluated a number of studies that we have not included in our evaluation. This is because the findings of those studies have not yet been published in English-language, peer-reviewed journals.

However, we know that the following two trials sponsored by the Repligen Corporation (and mentioned in the Cochrane Review) were terminated in 2004 because they were unsuccessful.

The Repligen Corporation was running a study to evaluate the efficacy of secretin in pre-school autistic children. Clinical Trials Gov Ref: NCT00036244. For more details, please see “A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multiple Dose Study to Assess the Efficacy, Safety and Tolerability of RG1068 (Synthetic Human Secretin) in Children with Autism.”
The Repligen Corporation was running at study to examine the effects of synthetic human secretin in autistic children with gastrointestinal dysfunction. Clinical Trials Gov Ref: NCT00036231. For more details please see “A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multiple Dose Study to Assess the Efficacy, Safety and Tolerability of RG1068 (Synthetic Human Secretin) in Children with Autism and Gastrointestinal Dysfunction”.

Related Additional Information

Secretin

Updated: 16 Jun 2022
Last Review: 01 Dec 2018
Next Review: 01 Aug 2024

Secretin and Autism Ranking:

Please Note

Our Opinion

Disclaimer

Audience

Aims and Claims

Aims

Claims

Key Features

Notes

Cost and Time

Cost

Time

Risks and Safety

Hazards

Contraindications

Notes

Suppliers and Availability

History

Current Research

Description of Studies

Outcomes of Studies

Status Research

Type of study

Participants

Intervention/s

Comparators

Outcomes

Other

Future Research

Summary of Existing Research

Recommendations for Future Research

Studies and Trials

Related Studies and Trials

Other Reading

Related Other Reading

Additional Information

Related Additional Information