Article: American Journal of Gastroenterology

Posted in Additional Information

Original Contribution
September 2000
Volume 95, Number 9
Pages 2285-2295

A. J. Wakefield, F.R.C.S.,a,b A. Anthony, 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. Walker-Smith, M.D., F.R.C.P., F.R.A.C.P., F.R.C.P.C.H.d

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 22 (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, Anthony A, Murch SH, Thomson M, Montgomery SM, Davies S, O'Leary JJ, Phil D, Berelowitz M and Walker-Smith JA. Enterocolitis in Children With Developmental Disorders. Am J Gastroenterol September;95:2285-2295.

a.University Departments of Medicine, b.Histopathology, c.Paediatric Gastroenterology, and d.Paediatric Psychiatry, Royal Free and e.University College Medical School, Royal Free Campus, London, United Kingdom, and University Department of Pathology, Coombe Women's Hospital and Trinity College, Dublin, Eire.


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Lisa S. Lewis, Ph.D.

Lisa S. Lewis, Ph.D. Lisa S. Lewis, Ph.D. is the author of Special Diets For Special Kids I & II, the foremost books on gluten and casein-free diets for children with disabilities.

Karyn Seroussi

Karyn Seroussi Karyn Seroussi is the author of Unraveling the Mystery of Autism and PDD, the story of her son's autism recovery through dietary and other biomedical interventions.

Helping since 1995

Together Lewis and Seroussi created the Autism Network for Dietary Intervention (ANDI.) Since 1995, ANDI has been helping and supporting parents using dietary and biomedical interventions for autism spectrum disorders. Last year, Lisa and Karyn again joined forces and put the sum of their knowledge in a new book, The Encyclopedia of Dietary Interventions. They continue to write and speak on the topic of dietary intervention, and to support other parents around the world.