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 19 April 2018

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News

Enterocolitis in children with developmental disorders associated with behavioral regression

Andrew Wakefield and colleagues describe some of the endoscopic and pathological characteristics in a group of children with developmental disorders that are associated with behavioral regression and bowel symptoms, and compares them with pediatric controls.

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Intestinal pathology, i.e., ileocolonic lymphoid nodular hyperplasia (LNH) and mucosal inflammation, has already been been described in children with developmental disorders.

Andrew Wakefield and colleagues from London, UK, report in September’s Am J Gastroenterol that they performed ileocolonoscopy and biopsy on 60 affected children with developmental disorders (median age 6 years, 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 years, range 2-13) 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.

Ileal LNH was present in 54 of 58 (93%) affected children and in five of 35 (14%) controls (P < 0.001). Colonic LNH was present in 18 of 60 (30%) affected children and in two of 37 (5%) controls (P < 0.01).

"A new variant of inflammatory bowel disease is present in this group of children with developmental disorders."

Andrew Wakefield.

Histologically, reactive follicular hyperplasia was present in 46 of 52 (89%) 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 22 (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).

The authors conclude that a new variant of inflammatory bowel disease is present in this group of children with developmental disorders.

In an accompanying editorial, Eamonn Quigley and David Hurley, from Cork, Ireland, write, "Wakefield et al. are to be congratulated on opening yet another window onto the ever-broadening spectrum of gut-brain interactions. Their findings raise many challenging questions that should provoke further much-needed research in this area, research that may provide true grounds for optimism for affected patients and their families."

Am J Gastroenterol 2000; 95: 2285-95.
25 September 2000

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