enterocolitis in children, Inflammation.doc

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Volume 95, Number 9

Pages 2285-2295

Enterocolitis in Children With Developmental

Disorders

G.I. disorders in Autism

GUT Problems in Autism

A. J. Wakefield, F.R.C.S.,a,b A. , M.Sc., Ph.D., M.B.B.S.,b S. H.

Murch, Ph.D., F.R.C.P., F.R.C.P.C.H.,b M. Thomson, MB.ChB., M.R.C.P.,

F.R.C.P.C.H.,c S. M. Montgomery, Ph.D.,c S. Davies, M.R.C.Path.,b J. J.

O'Leary, M.D., D.Phil., M.R.C.Path.,b M. Berelowitz, F.R.C.Psych.,e and J.

A. -, M.D., F.R.C.P., F.R.A.C.P., F.R.C.P.C.H.

* OBJECTIVE:

Intestinal pathology, i.e., ileocolonic lymphoid nodular hyperplasia (LNH) and

mucosal inflammation, has been described in children with developmental

disorders. This study describes some of the endoscopic and pathological

characteristics in a group of children with developmental disorders (affected

children) that are associated with behavioral regression and bowel symptoms, and

compares them with pediatric controls.

* METHODS:

Ileocolonoscopy and biopsy were performed on 60 affected children (median age

6 yr, range 3-16; 53 male). Developmental diagnoses were autism (50 patients),

Asperger's syndrome (five), disintegrative disorder (two), attention deficit

hyperactivity disorder (ADHD) (one), schizophrenia (one), and dyslexia (one).

Severity of ileal LNH was graded (0-3) in both affected children and 37

developmentally normal controls (median age 11 yr, range 2-13 yr) who were

investigated for possible inflammatory bowel disease (IBD). Tissue sections

were reviewed by three pathologists and scored on a standard proforma. Data

were compared with ileocolonic biopsies from 22 histologically normal children

(controls) and 20 children with ulcerative colitis (UC) scored in an identical

manner. Gut pathogens were sought routinely.

RESULTS:

* Ileal LNH was present in 54 of 58 (93%) affected children and in five of 35

(14.3%) controls (p < 0.001). Colonic LNH was present in 18 of 60 (30%)

affected children and in two of 37 (5.4%) controls (p < 0.01). Histologically,

reactive follicular hyperplasia was present in 46 of 52 (88.5%) ileal biopsies

from affected children and in four of 14 (29%) with UC, but not in non-IBD

controls (p < 0.01). Active ileitis was present in four of 51 (8%) affected

children but not in controls. Chronic colitis was identified in 53 of 60 (88%)

affected children compared with one of 2 (4.5%) controls and in 20 of 20 (100%)

with UC. Scores of frequency and severity of inflammation were significantly

greater in both affected children and those with UC, compared with controls (p <

0.001).

CONCLUSIONS:

* A new variant of inflammatory bowel disease is present in this group of

children with developmental disorders.

*

* Cite this article as: . Wakefield AJ, A, Murch SH, Thomson M,

Montgomery SM, Davies S, O'Leary JJ, Phil D, Berelowitz M and - JA.

Enterocolitis in Children With Developmental Disorders. Am J Gastroenterol

September;95:2285-2295. University Departments of Medicine, bHistopathology,

cPaediatric Gastroenterology, and dPaediatric Psychiatry, Royal Free and

eUniversity College Medical School, Royal Free Campus, London, United Kingdom,

and University Department of Pathology, Coombe Women's Hospital and Trinity

College, Dublin, Eire