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 22 May 2018

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High rate of ileo-colonic lymphoid nodular hyperplasia in autism

Ileo-colonic lymphoid nodular hyperplasia is a characteristic pathological finding in children with ASD and gastrointestinal symptoms, reports the most recent issue of the European Journal of Gastroenterology & Hepatology.

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Intestinal mucosal pathology is characterized by ileo-colonic lymphoid nodular hyperplasia, mild acute and chronic inflammation of the colorectum, small bowel and stomach.

It has been reported in children with autistic spectrum disorder.

Dr Andrew Wakefield and colleagues assessed ileo-colonic lymphoid nodular hyperplasia in autistic spectrum disorder and control children.

The research team tested the hypothesis that there is an association between ileo-colonic lymphoid nodular hyperplasia and autistic spectrum disorder in children.

The team included 148 consecutive children with autistic spectrum disorder, of which 127 were male with gastrointestinal symptoms with a median age of 6 years.

Gastrointestinal symptoms were investigated by ileo-colonoscopy.

The researchers scored and compared macroscopic and histological features of different groups.

Ileal lymphoid nodular hyperplasia occurred in 90% with autistic spectrum disorder vs 30% in controls
European Journal of Gastroenterology & Hepatology

Group 1 included 30 developmentally normal controls, of which 25 were males with median age of 7 years with no inflammatory bowel disease or celiac disease.

The team reported that Group 2 included 16 cases showing mild non-specific colitis, of which 13 were male.

Group 3 included 14 cases with normal colonic histology, of which 12 were male.

The researchers reported that from these groups, 74 children with autistic spectrum disorder and 23 controls underwent upper gastrointestinal endoscopy.

The influence on ileal lymphoid nodular hyperplasia of dietary restriction, and age at colonoscopy was examined.

In addition, the team examined co-existent lymphoid nodular hyperplasia elsewhere in the intestine.

The researchers found that the prevalence of lymphoid nodular hyperplasia in the ileum was 90% with autistic spectrum disorder compared with 30% controls.

Lymphoid nodular hyperplasia in the colon occurred more often in the group with autistic spectrum disorder, at 59% versus controls at 23%.

The researchers found that these results persisted whether or not controls had co-existent colonic inflammation.

The severity of ileal lymphoid nodular hyperplasia was significantly greater in children with autistic spectrum disorder compared with controls.

The research team observed that moderate to severe ileal lymphoid nodular hyperplasia was present in 68% of children with autism versus 15% in controls .

The team noted that severe ileal lymphoid nodular hyperplasia was associated with co-existent colonic lymphoid nodular hyperplasia in children with autism.

However, the presence and severity of ileal lymphoid nodular hyperplasia was not influenced by either diet or age at colonoscopy.

The team noted that isolated ileal lymphoid nodular hyperplasia without evidence of pathology elsewhere in the intestine occurred in less than 3% of children.

On histopathological examination, hyperplastic lymphoid follicles were found to be more prevalent in the ileum of children with autistic spectrum disorder versus controls.

Dr Wakefield's team concluded, “Ileo-colonic lymphoid nodular hyperplasia is a characteristic pathological finding in children with autistic spectrum disorder and gastrointestinal symptoms.”

“It is associated with mucosal inflammation, and differences in age at colonoscopy and diet do not account for these changes.”

“The data support the hypothesis that lymphoid nodular hyperplasia is a significant pathological finding in children with autistic spectrum disorder.”

Eur J Gastroenterol & Hepatol 2005: 17(8): 827-36
13 July 2005

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