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Posted by Margaret on September 19, 2000 at 17:52:00:

American Journal of Gastroenterology, September, 2000

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. aUniversity Departments of
Medicine, bHistopathology, cPaediatric Gastroenterology, and dPaediatric Psychiatry, Royal Free and
eUniversity 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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