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Journal ArticleDOI

Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

28 Feb 1998-The Lancet (Elsevier)-Vol. 351, Iss: 9103, pp 637-641
TL;DR: In this paper, the authors investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder, and identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
About: This article is published in The Lancet.The article was published on 1998-02-28. It has received 2505 citations till now. The article focuses on the topics: Pervasive developmental disorder & Lymphoid hyperplasia.
Citations
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Journal ArticleDOI
TL;DR: The aim of this review is to summarize the key findings from genetic and epidemiological research, which show that autism is a complex disorder resulting from the combination of genetic and environmental factors.
Abstract: The aim of this review is to summarize the key findings from genetic and epidemiological research, which show that autism is a complex disorder resulting from the combination of genetic and environmental factors. Remarkable advances in the knowledge of genetic causes of autism have resulted from the great efforts made in the field of genetics. The identification of specific alleles contributing to the autism spectrum has supplied important pieces for the autism puzzle. However, many questions remain unanswered, and new questions are raised by recent results. Moreover, given the amount of evidence supporting a significant contribution of environmental factors to autism risk, it is now clear that the search for environmental factors should be reinforced. One aspect of this search that has been neglected so far is the study of interactions between genes and environmental factors.

557 citations

Journal ArticleDOI
TL;DR: It is speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology.
Abstract: In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism.

555 citations

Journal ArticleDOI
TL;DR: Results indicate greater prevalence ofGI symptoms among children with ASD compared with control children, and future research must address critical questions about the causes and long-term impact of GI symptoms in ASD.
Abstract: BACKGROUND: In pediatric settings, parents often raise concerns about possible gastrointestinal (GI) symptoms in autism spectrum disorder (ASD), yet the specificity of these concerns are not well studied. OBJECTIVE: To conduct a meta-analysis of research investigating GI symptoms among children with ASD. METHODS: We searched Medline, PsycINFO, and PubMed databases (1980–2012) in peer-reviewed journals. Analysis involved studies with a comparison group presenting quantitative data on GI symptoms using combinations of terms for ASD and GI indicators. The systematic search yielded 15 studies. We calculated effect sizes and 95% confidence intervals (CIs) using a random-effects model. RESULTS: Children with ASD experience significantly more general GI symptoms than comparison groups, with a standardized mean difference of 0.82 (0.24) and a corresponding odds ratio (OR) of 4.42 (95% CI, 1.90–10.28). Analysis also indicated higher rates of diarrhea (OR, 3.63; 95% CI, 1.82–7.23), constipation (OR, 3.86; 95% CI, 2.23–6.71), and abdominal pain (OR, 2.45; 95% CI, 1.19–5.07). CONCLUSIONS: Results indicate greater prevalence of GI symptoms among children with ASD compared with control children. Identified studies involved high methodological variability and lack of comprehensive data prohibited analysis of GI pathophysiologies (eg, gastroesophageal reflux) typically associated with organic etiologies, limiting conclusions about the underpinnings of the observed association. Future research must address critical questions about the causes and long-term impact of GI symptoms in ASD. Such analyses will require more systematic research and clinical activities, including improved diagnostic screening, standardized assessment, and exploration of potential moderators (eg, dietary restrictions).

547 citations

Journal ArticleDOI
TL;DR: The current emphasis on deciphering autism spectrum disorders has accelerated the field of neuroscience and demonstrated the necessity of multidisciplinary research that must include clinical geneticists both in the clinics and in the design and implementation of basic, clinical, and translational research.

519 citations

Journal ArticleDOI
TL;DR: This review will examine the status of the research linking the immune response with ASD and the potential that aberrant immune activity during vulnerable and critical periods of neurodevelopment could participate in the generation of neurological dysfunction characteristic of ASD.
Abstract: Autism spectrum disorders (ASD) are part of a broad spectrum of neurodevelopmental disorders known as pervasive developmental disor- ders, which occur in childhood. They are charac- terized by impairments in social interaction, verbal and nonverbal communication and the presence of restricted and repetitive stereotyped behaviors. At the present time, the etiology of ASD is largely unknown, but genetic, environmental, immunolog- ical, and neurological factors are thought to play a role in the development of ASD. Recently, increas- ing research has focused on the connections be- tween the immune system and the nervous system, including its possible role in the development of ASD. These neuroimmune interactions begin early during embryogenesis and persist throughout an individual's lifetime, with successful neurodevelop- ment contingent upon a normal balanced immune response. Immune aberrations consistent with a dysregulated immune response, which so far, have been reported in autistic children, include abnor- mal or skewed T helper cell type 1 (TH1)/TH2 cytokine profiles, decreased lymphocyte numbers, decreased T cell mitogen response, and the imbal- ance of serum immunoglobulin levels. In addition, autism has been linked with autoimmunity and an association with immune-based genes including hu- man leukocyte antigen (HLA)-DRB1 and comple- ment C4 alleles described. There is potential that such aberrant immune activity during vulnerable and critical periods of neurodevelopment could participate in the generation of neurological dys- function characteristic of ASD. This review will examine the status of the research linking the im- mune response with ASD. J. Leukoc. Biol. 80: 1-15; 2006.

500 citations


Cites background from "Ileal-lymphoid-nodular hyperplasia,..."

  • ...children with ASD [117, 118], in which chronic, ileo-colonic...

    [...]

References
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Reference EntryDOI
11 Jun 2013

113,134 citations

Book
10 May 2001
TL;DR: A simple system of subgrouping based solely on a description of the type of social impairment will be used, which avoids the confusion inherent in trying to identify the named syndromes.
Abstract: simple practical skills and social adaptation from early childhood and that abnormalities were recognisable from the second year of life. Many clinicians diagnose on their interpretation of Asperger’s clinical descriptions, rather than insisting on normal development before 3 years in the areas mentioned. In this article, a simple system of subgrouping based solely on a description of the type of social impairment will be used, which avoids the confusion inherent in trying to identify the named syndromes. This simple subgrouping has proved helpful in clinical practice even though the groups are no more sharply differentiated and permanent than in any other existing method of classification in the specialty.

524 citations


"Ileal-lymphoid-nodular hyperplasia,..." refers background or methods in this paper

  • ...[ 15 ] Rubella virus is associated with autism and the...

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  • ...[ 15 ] In the context of susceptibility to infection, a genetic...

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Journal ArticleDOI
TL;DR: It is speculated that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.
Abstract: We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64% +/- 1.43 vs 0.38% +/- 0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.

382 citations


"Ileal-lymphoid-nodular hyperplasia,..." refers background in this paper

  • ...Walker-Smith and colleagues [5] detected low concentrations of alpha-1 antitrypsin in children with typical autism, and D'Eufemia and colleagues [ 6 ] identified abnormal intestinal permeability,...

    [...]

Journal ArticleDOI
TL;DR: Panksepp et al. as discussed by the authors put forward the idea that autism is an emotional disturbance arising from an upset in the opiate systems in the brain, and hence proposed, as a possibility, opiate antagonist therapy for the autistic syndrome.

303 citations


"Ileal-lymphoid-nodular hyperplasia,..." refers background in this paper

  • ...The "opioid excess" theory of autism, put forward first by Panksepp and colleagues [ 7 ] and later by Reichelt and colleagues [8] and Shattock and colleagues [9] proposes that autistic...

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