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Dr. Timothy Buie and Dr. Andrew Wakefield have been working tirelessly to determine the cause of inflammation in children with autism; they have focused their academic lenses on the malfunctioning of the gastrointestinal tract.

According to Buie, pain is likely not a problem in all children with autism, but a subgroup of autistic children have been reported to have low pain sensitivity and hypersensitivity to non-painful stimuli.  In terms of the gastrointestinal tract, pain might be associated with a local site of injury, such as esophagitis, enteritis, colitis and allergy.  According to Molloy (2003), 24% of children with autism have chronic GI symptoms; Horvath (2002) reports about 70% of autistic children have GI issues or food allergy.

Autistic children generally present pain atypically:

bulletcry without localization of discomfort,
bulletsleep disruption and crying upon waking
bulletunexplained outbursts
bulletaggression
bulletself-injury

Why does self-injury occur?

bullettrying to improve state of arousal, or "wake themselves up"
bullettrying to stimulate release of endorphins, as seen in physical exercise (feeling good after the pain of a workout)
bulletresponse to frustration
bulletinability to respond to pain in a typical manner

What might gastrological pain look like in infants? (From Rudolph et. al. 2001):

bulletfeeding refusal
bulletrecurrent vomiting
bulletpoor weight gain
bulletirritability
bulletapnea
bulletarching or head tilting, torticollis

Older child or adolescent:

bulletrecurrent vomiting
bulletheartburn
bulletesophagitis
bulletdysphagia
bulletasthma
bulletrecurrent pneumonia
bulletupper airway symptoms (chronic cough, hoarse voice)

Less common symptoms:

bullethematemesis (vomiting blood)
bulletiron deficiency anemia
bulletimpaired growth
bulletrecurrent cough
bulletwheezing
bulletSandifer's syndrome (posturing)
bulletdental erosions

Seasonal and food allergy may cause pain from both local inflammation and circulating cytokines.  Allergy testing is often unreliable.  For example, skin and IgE tests can be negative in up to 20% of children who have documented allergy to peanuts (Clark 2003).  Elimination and rechallenge are the standard evaluation for food sensitivity.  In addition, stress and anxiety can alter perception of taste and contribute to food aversion (Guitton 2004).  Stress can also reactivate or exacerbate inflammatory bowel disease (Hollander 2003).

In 1998, Dr. Andrew Wakefield and his colleagues at the Royal Free Hospital reported a novel inflammatory bowel disease in children with developmental disorders such as autism; the condition later became known as autistic enterocolitis. No stranger to controversy, Dr. Wakefield resisted pressure to stop his research on the possible links between childhood immunizations, intestinal inflammation and autism, and left the Royal Free School of Medicine in 2001....

Killing the Messenger...

Dateline: 12/05/01

"Dr. Andrew Wakefield, the autism researcher who found the a potential link between the Measles - Mumps - Rubella vaccine (MMR) and autism has been fired by the Royal Free Hospital in London. Ironically, this news comes one day after a researcher at Harvard University substantially replicated the results of Wakefield's research, the first step at proving a hypothesis to be true according to the scientific method.

Dr. Timothy Buie, a pediatric gastroenterologist from Harvard/Mass General Hospital who has been conducting independent research similar to that reported by Dr. Wakefield in Great Britain. According to his findings, which came about as the result of over 400 gastrointestinal endoscopies with biopsies, as well as evaluation of digestive enzyme function in children diagnosed with autism and finding a connection, the chronic inflammation of the intestinal tract observed by Dr. Wakefield is present in a significant number of cases, although the incidence was noted to be less frequent in his group.

Buie announced his findings during the Oasis 2001 Conference for autism in Portland, Oregon. His findings are leading him to conduct more research into dietary treatments for autism, including gluten free - casein free diets for autistic children. His findings have also been supported by research done at the University of Maryland, by Dr. Karoly Horvath and others, who obtained essentially similar results to those found by both Wakefield and Buie.

Dr. Wakefield, who is recognized by many in the autism community worldwide as an authority on autism, told parents involved in his research, "I realise now that everything that has happened to me was inevitable from the beginning. If you offend the system, then the system will take its revenge." As a result, parent and Autism groups around the world are reacting with horror to the termination of Dr. Wakefield by the hospital.

Now, at the time when his research has been validated by independent researchers in other countries, Wakefield finds himself on the outside looking in, at least as far as the Royal Free Hospital is concerned. While he still will have access to patients that were under his program, according to a message that he sent to concerned parents. Always the optimist, despite the jabs made at him by many in the medical community, Wakefield said, "One great benefit of this arrangement is that I shall no longer have to spend a considerable amount of time in distracting political negotiations with the Medical School and will be able to devote 100% of my effort to the research."

It brings to mind the story from mythology in which the messenger who brought news of the defeat of the army in battle, was killed for delivering unpleasant news to the king.  His death, however, did not change the fact that the battle was lost. In Dr. Wakefield's case, the medical establishment may have tried to kill the messenger, but the message did not change. It remained constant, and has now been validated by others."

Wakefield's discovery shook the public health establishment and made headlines around the world.  How could a virus introduced to infants by vaccine possibly establish a colony in the gut that would ultimately lead to the development of autism?

Illeolymphonodular hyperplasia is characterized by widespread inflammation in the intestines and is triggered by infection or allergy.   In children with ASD, the deposition of antibodies in cells, colocalization of antibody and complement suggests that an antigen in the gut is driving the adaptive response.  When the immune system is skewed by chronic inflammation, such as in AIDS and mononucleosis, you can find the pathogen in the lymphoid follicle of the intestine.  In children with autism, Wakefield has found the measles virus, a finding that has been replicated and confirmed by multiple subsequent studies around the world.

Autistic children with bowel disease also have a significantly higher rate of eczema, allergies, asthma and rhinitis.  Something about the immune system is causing these children to have unusual responses to environmental and introduced insults.  Welsh (Journal of Neuroscience 2005) has found that primary bowel inflammation switches on areas of the brain involved in autism; they only need to be triggered once to wreck havoc on the child's system.  As a result, brain injury becomes a consequence of gut inflammation.  The adaptive immune system is activated in the gut, which causes inflammation, which in turn leads to neurological damage.  This phenomenon has been well documented in cases of celiac disease, gluten ataxia and others.

Bibliography

CDD and Gastrointestinal Disease

  1. Wakefield AJ, Anthony A, Murch SH, Thomson M, Montgomery SM, Davies S, Walker-Smith JA. Enterocolitis in children with developmental disorder. American Journal of Gastroenterology 2000;95:2285-2295

     
  2. Furlano RI, Anthony A, Day R, Brown A, McGavery L, Thomson MA, Davies SE, Berelowitz M, Forbes A, Wakefield AJ, Walker-Smith JA, Murch SH. Colonic CD8 and gamma delta T-cell infiltration with epithelial damage in children with autism. Journal of Pediatrics 2001;138:366-72.

     
  3. Wakefield AJ. The New Autism (Invited Article) Clinical Child Psychology & Psychiatry 2002 2002;7:518-528

     
  4. Wakefield AJ., Puleston J. Montgomery SM., Anthony A., O’Leary J.J., Murch SH Entero-colonic encephalopathy, autism and opioid receptor ligands. Alimentary Pharmacology & Therapeutics. 2002;16:663-674

     
  5. Torrente F., Machado N., Perez-Machado M., Furlano R., Thomson M., Davies S., Wakefield AJ, Walker-Smith JA, Murch SH. Enteropathy with T cell infiltration and epithelial IgG deposition in autism. Molecular Psychiatry. 2002;7:375-382

     
  6. Anthony A, Ashwood P., Wakefield AJ. The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder. European Journal of Gastroenterology and Hepatology 2004 (in press)

     
  7. Ashwood P, Anthony A, Pellicer AA, Torrente F, Wakefield AJ. Intestinal lymphocyte populations in children with regressive autism: Evidence for extensive mucosal immunopathology. Journal of Clinical Immunology, 2003;23:504-517.

     
  8. Ashwood P, Anthony A, Torrente F, Wakefield AJ., Spontaneous mucosal lymphocyte cytokine profiles in children with regressive autism and gastrointestinal symptoms: Mucosal immune activation and reduced counter regulatory interleukin-10. Journal of Clinical Immunology. 2004:24:664-673

     
  9. The Gut-Brain Axis in Childhood Developmental Disorders: Viruses and Vaccines. Wakefield AJ., Collins I., Ashwood P. Invited chapter in Infectious Disease and Neuropsychiatric Disorders (in press)

     
  10. Wakefield AJ. The Gut-Brain Axis in Childhood developmental Disorders. Journal of Pediatric Gastroenterology and Nutrition. 2002;34:S14-S17

Etiology of CDD

  1. Wakefield AJ and Montgomery SM. Autism, viral infection and measles mumps rubella vaccination. Israeli Medical Association Journal 1999;1:183-187

     
  2. Montgomery SM, Morris DL, Pounder RE, Wakefield AJ. Paramyxvorus infections in childhood and subsequent inflammatory bowel disease. Gastroenterology 1999;116:796-803

     
  3. Kawashima H., Takayuki M., Kashiwagi Y., Takekuma K., Hoshika A., Wakefield AJ. Detection and sequencing of measles virus from peripheral blood mononuclear cells from patients with inflammatory bowel disease and autism. Digestive Diseases and Sciences. 2000;45:723-729

     
  4. Wakefield AJ and Montgomery SM. Measles, mumps, rubella vaccine: through a glass, darkly. Adverse Drug Reactions & Toxicological Reviews 2000;19:265-283

     
  5. Uhlmann V., Martin C, Shiels, Wakefield AJ, O.Leary JJ. Possible viral pathogenesis of a novel paediatric inflammatory bowel disease. Molecular Pathology 2002;55:84-90

     
  6. Bradstreet JJ., ,El Dahr J., Anthony A., Kartzinel J., Wakefield AJ, Detection of Measles Virus Genomic RNA in Cerebrospinal Fluid of Children with Regressive Autism: a Report of Three Cases Journal of American Physicians and Surgeons. 2004.9:39-45

     
  7. Wakefield AJ. Enterocolitis, autism and measles virus. Molecular Psychiatry. 2002;7:S44-46

     
  8. O'Leary JJ, Uhlmann V, Wakefield AJ. Measles virus and autism. Lancet. 2000;356:772 (letter)

     
  9. Wakefield AJ. MMR vaccination and autism. Lancet. 1999;354:949-50 (letter)

     
  10. Stott C., Blaxill M., Wakefield AJ. MMR and Autism in Perspective: the Denmark Story. Journal of American Physicians and Surgeons 2004;9:89-91

     
  11. Wakefield AJ. Entero-colitis, Autism and Measles Virus. Consensus in Child Neurology. 2002;6:74-77

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