The Debate Continues on Autistic Enterocolitis
Journalist Brian Deer has written a special report appearing in the British Medical Journal (BMJ) that addresses a controversial bowel condition in autistic children first described by Dr. Andrew Wakefield and colleagues as “autistic enterocolitis.”
Autistic enterocolitis was described in a report presented to the American Gastroenterology Association in 2005 as a disease of the upper and lower intestinal tract that leads to hyperplasia (excessive growth of cells) and chronic inflammation. Symptoms include abdominal pain, bloating, constipation and/or diarrhea.
Dr. Wakefield’s paper, published in the journal Lancet in 1998, was recently retracted. In it, he discusses the cases of 12 children admitted to the Royal Free Hospital’s pathology service and had biopsies of the bowel. The study indicated that 11 of the 12 children had “non-specific colitis”, which is a clinically significant inflammation of the large bowel. It was thought at the time that the connection between autism and colitis was linked to the children receiving the Measles, Mumps Rubella (MMR) vaccine.
Mr. Deer has obtained reports from the hospital which indicate that eight of the 11 diagnosed children had normal biopsies. Dr. Susan Davies, a consultant histopathologist and co-author on the study, said during a trial by the General Medical Council that she had been concerned about the use of the term colitis when the Lancet paper was published because she had not found anything abnormal.
Other inflammatory measures were also found upon the review to be normal, for example serum C-reactive protein. This was not reported in the original Lancet journal, according to Deer’s findings.
In one of the children, called child number 2 in the reports, a “mild patchy generalized increase in inflammatory cells with lymphoid aggregates and follicles...could be in keeping with low grade quiescent inflammatory bowel disease.” That child went on enteral (tube) feedings of a specialized product now known as Modulen for two months. A repeat ileocolonoscopy was found normal, and the child was diagnosed with a food intolerance.
Today, the actual biopsy slides are not available to confirm or refute the reports and since 10 of Wakefield’s co-authors have renounced their conclusions. Independent experts have reviewed the hospital reports of the biopsies and have failed to find any distinctive inflammation that would lead to the diagnosis of a new disease called “autistic enterocolitis”.
In an editorial accompanying the BMJ report, Sir Nicholas Wright, from Barts and the London School of Medicine, points out that histopathological interpretation is a matter of opinion. “We should remember, as recent experience in several fields has shown, that although science has its defects, it is a self-correcting process.”
So does autistic enterocolitis exist? According to Deer, several studies have since shown an association between inflammation in the colon and autistic spectrum disorder, but the data is very limited, and any firm conclusion would be inadvisable. He states that he is not questioning whether or not autistics have a greater prevalence of GI issues, but whether there is a specific bowel disease unique to autistic spectrum disorders.