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Clinical Presentation and Histologic Findings at

Ileocolonoscopy in Children with Autistic Spectrum Disorder and Chronic

Gastrointestinal SymptomsAuthors: Arthur Krigsman, Marvin Boris,

Alan Goldblatt and Carol Stott

Publication Date: 27 Jan 2010

Autism Insights 2010:2 1-11

Arthur Krigsman1, Marvin Boris2, Alan

Goldblatt3 and Carol Stott4

1Assistant Professor of Pediatrics, New York University School

of Medicine Director of Gastroenterology Services, Thoughtful House

Center for Children, 3001 Bee Caves Rd, Austin, Texas, 78746, USA.

2Associate Clinical Professor of Pediatrics, New York

University School of Medicine, 550 1st Ave., New York, NY 10016, USA.

3Adjunct Professor Touro College, 27-33 West 23rd St, New

York, NY 10010, USA. 4Thoughtful House Center for Children,

3001 Bee Caves Rd, Austin, Texas, 78746, USA.

Abstract

Background: Children with developmental disorders experience

chronic gastrointestinal symptoms.

Aims: To examine the nature of these gastrointestinal symptoms

and histologic findings in children with autism spectrum/developmental

disorders and ileocolonic disease.

Methods: Chart review. 143 autism spectrum/developmental

disorder patients, with chronic gastrointestinal symptoms, undergoing

diagnostic ileocolonoscopy.

Results: Diarrhea was present in 78%, abdominal pain in 59%

and constipation in 36%. Ileal and/or colonic lymphonodular hyperplasia

(LNH), defined as the presence of an increased number of enlarged

lymphoid follicles, often with hyperactive germinal centers, was present

in 73.2%. Terminal ileum LNH presented visually in 67% and histologically

in 73%. Colonic LNH was multifocal and presented histologically in 32%.

Ileal and/or colonic inflammation presented in 74%, consisting primarily

of active or chronic colitis (69%). Ileal inflammation presented in 35%.

Presence of LNH significantly predicted mucosal inflammation. Patients

with ileal and/or colonic LNH had lower mean/median age than those

without; patients with ileal and/or colonic inflammation had lower

mean/median age than those without. There was a significant association

between ileo and/or colonic inflammation or LNH, and onset of

developmental disorder; plateaued or regressive onset conferred greater

risk than early onset.

Conclusions: Patients with autism or related disorders exhibiting

chronic gastrointestinal symptoms demonstrate ileal or colonic

inflammation upon light microscopic examination of biopsy tissue. Further

work is needed to determine whether resolution of histopathology with

appropriate therapy is accompanied by GI symptomatic and

cognitive/behavioral improvement.

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