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.