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Autistic enterocolitis

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#1 tictoc


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Posted 03 September 2005 - 11:41 AM

--From TAAP (The Autism Autoimmunity Project) newsletter
From F. Edward Yazbak, MD (TLAutStudy@aol.com)

Presented to the American Gastroenterological Association. May 2005
Autistic enterocolitis: confirmation of a new inflammatory bowel disease in an
Italian cohort of patients.

Federico Balzola, Clauser Daniela*, Alessandro Repici, Valeria Barbon, Anna
Sapino***, Cristiana Barbera**, Pier Luigi Calvo**, Marina Gandione*, Roberto
Rigardetto*, Mario Rizzetto.

Dept of Gastroenterology. University of Turin. Molinette Hospital Turin, Italy

*Dept of Neuropsychiatry for Children. University of Turin Regina Margherita
Pediatric Hospital, Turin, Italy ** Dept of Pediatric Gastroenterology.
University of Turin Regina Margherita Pediatric Hospital, Turin, Italy *** Dept
of Biomedical Science and Human Oncology University of Turin

Although the causes of autism are largely unknown, this long-life developmental
disorder is now recognised to affect as many as 1 to 500 children. An upper and
lower intestinal disease has been recently described in these patients (pts) in
spite of gastrointestinal symptoms have been reported by the parents back more
many years. This disorder comprising ileo-colonic lymphoid nodular hyperplasia
(LNH) and chronic inflammatory colonic disease was called autistic enterocolitis:
an association between autism and bowel disease was then proposed.

Patients and Methods
Nine consecutive male pts (mean age 18 years, range 7-30 years) with a diagnosis
of autism according to ICD-10 criteria that showed chronic intestinal symptoms
(abdominal pain, bloating, constipation and/or diarrhoea) were enrolled. After
routinely blood and stool tests, gastroscopy and colonoscopy with multiple biopsies
were performed under sedation. A wireless enteroscopy capsule was also performed in 3 adult pts.

Anemia and fecal blood positive test were found in 2 pts and 3 pts,
respectively. Gastroscopy revealed mucosal gastritis in 4 pts, esophagitis in 1
and duodenitis in 1 pts. Histological findings showed a chronic inflammation of
the stomach and duodenum in 6 pts (65%) but inconsistent with celiac disease.
Macroscopic mucosal abnormalities (aphtoid ulcerations and loss of vascular
pattern) were found in 1 pts at colonoscopy and a LNH in the terminal ileum in 4
pts. Microscopic colitis with intraepithelial lymphocytes and eosinophils
infiltrations, mucosal atrophy and follicular hyperplasia was histologically
present in all the pts (100%) whereas a chronic inflammation with iperemia and
villous shortening of the terminal ileum was shown in 6 (65%) pts. The wireless
capsule revealed areas of bleeding or patchy erythema, mucosal erosions and
ulcers in both jejunum and ileum in 1 patients whereas a particular chronic
jejunum and ileal erosive pattern was evident in the other two.


These preliminary data are strongly consistent with previous descriptions of
autistic enterocolitis and supported a not-coincidental occurrence. Moreover,
they showed for the first time a small intestinal involvement, suggesting a
panenteric localisation of this new IBD. The treatment to gain clinical
remission has still to be tried and it will be extremely important to ameliorate
the quality of life of such pts who are likely to be overlooked because of their
long-life problems in the communication of symptoms.

The American Journal of Gastroenterology 100 (4) Pg 979 - April 2005
Panenteric IBD-Like Disease in a Patient with Regressive Autism Shown for the
First Time by the Wireless Capsule Enteroscopy: Another Piece in the Jigsaw of
this Gut-Brain Syndrome?

Federico Balzola, M.D. Valeria Barbon, M.D. Alessandro Repici, M.D. Mario
Rizzetto, M.D. Daniela Clauser, M.D. Marina Gandione, M.D. Anna Sapino, M.D.

TO THE EDITOR: Although the causes of autism are largely unknown, this life-long
developmental disorder is now showing a strong increase of prevalence (1/500).
Intestinal disease was first described in 1998 in these patients (1) although
there have been indications of impaired gastrointestinal function in the past (2).
This disorder, comprising ileo-colonic lymphoid nodular hyperplasia and chronic
inflammatory colonic disease, was called autistic enterocolitis; an association
between autism and bowel disease was then proposed (3). More recently, a novel
form of focal gastritis has also been described in these patients (4).

A 28-yr-old male with regressive autism recently came to our attention with
unexplained microcytic anemia requiring intravenous iron supplementation. Severe
constipation with bloating and abdomen distension and symptoms of
gastroesophageal reflux were reported by parents. Gastroscopy under general
anesthesia revealed hemorrhagic gastritis with inflammatory pseudopolyps that
reached the pylorum with a "pearl necklace" appearance. The biopsies in the
stomach and duodenum confirmed the chronic active inflammation whereas those
in the second part of the duodenum were inconsistent with celiac disease.
The whole colon and the terminal ileum were macroscopically normal at colonoscopy,
whereas random biopsies showed a chronic severe active mucosal inflammation
(intraepithelial lymphocytes and eosinophyls infiltrations and villous focal
atrophy with reactive lymphoid nodular with intraepithelial CD3 and mucosal
CD8), compatible with active IBD. The wireless enteroscopy capsule (GIVENŽ
Imaging Diagnostic System), revealed areas of patchy erythema, mucosal
erosions, and ulcers in both jejunum and ileum . A panenteric
IBD-like disease, consistent with previous descriptions of autistic enterocolitis, was finally diagnosed.

The patient is currently receiving immunosuppressive agents with clinical
improvement in both gastrointestinal and behavioral symptoms. To our knowledge,
these are the first images of small intestinal disease in autism beyond the
limits of the duodenum and terminal ileum. They demonstrate the potential for
involvement of the entire bowel in this inflammatory disease. We think that the
published data together with our findings are more than a simple coincidence.
The response to treatment in this patient had positive effects on his behavior,
suggesting that inflammatory involvement of the entire bowel undoubtedly worsens
the quality of life of such patients who are likely to be overlooked because of
their life-long problems in the communication of symptoms.


Autism is 1 in 150 children today, 1 in 68 families! TAAP (The Autism
Autoimmunity Project) is a non-profit charity dedicated to obtaining funding for
independent research into the cause, treatment and prevention of autism and
other autoimmune disorders. Please learn from our mistake and "Educate BEFORE
You Vaccinate!" For more information visit our website at www.TAAP.info and
"TAAP into the Truth!"

#2 tictoc


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Posted 05 September 2005 - 08:34 AM

I also posted this in ADHD but it has general applicability.

The Other Brain, the One With Butterflies, Also Deals With Many Woes


Published: August 23, 2005


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