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Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
A J Wakefield1, S H Murch, A Anthony
1Inflammatory Bowel Disease Study Group, University Department of Medicine, Royal Free Hospital and School of Medicine, London, UK.
Insights
Children with chronic enterocolitis and developmental regression showed intestinal abnormalities and elevated urinary methylmalonic acid. These cases suggest a link between gastrointestinal issues and developmental disorders in children.
Area of Science:
- Pediatric Gastroenterology
- Developmental Neuroscience
- Immunology
Background:
- Investigated children with chronic enterocolitis and regressive developmental disorder.
- Studied a series of 12 children with normal development followed by skill loss, diarrhea, and abdominal pain.
Purpose of the Study:
- To identify associations between gastrointestinal disease and developmental regression in children.
- To explore potential environmental triggers for these conditions.
Main Methods:
- Gastroenterological, neurological, and developmental assessments.
- Ileocolonoscopy, MRI, EEG, lumbar puncture, and barium radiography.
- Biochemical, hematological, and immunological profiling.
Main Results:
- All 12 children had intestinal abnormalities (e.g., lymphoid hyperplasia, aphthoid ulceration).
- Behavioral disorders included autism and disintegrative psychosis; MRI and EEG were normal.
- Elevated urinary methylmalonic acid (p=0.003), low hemoglobin (4/12), and low serum IgA (4/12) were noted.
Conclusions:
- Identified associated gastrointestinal disease and developmental regression in previously normal children.
- Observed a temporal association with possible environmental triggers, including vaccinations.
- Highlighted the need for further research into the complex interplay of factors contributing to these disorders.
Background:
We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder.
Methods:
12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.
Findings:
Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children.
Interpretation:
We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.