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Autistic enterocolitis

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--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

 

Introduction

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.

 

Results

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.

 

Conclusions

 

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 (GIVEN®

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.

 

===========================================

 

DEFINITION * TREATMENT * PREVENTION

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!"

____________<end>

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