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04/08/2002
Reprinted by permission of the author, National Library of Medicine - NLM
The concept of entero-colonic encephalopathy, autism and opioid receptor ligands.
Wakefield AJ, Puleston JM, Montgomery SM, Anthony A, O'Leary JJ, Murch SH.
Inflammatory Bowel Disease Study Group, Royal Free and University College Medical School, London, UK, Centre for Gastroenterology, Royal Free and University College Medical School, London, UK, Centre for Paediatric Gastroenterology, Royal Free and University College Medical School, London, UK, Department of Pathology, Coombe Women's Hospital and Trinity College, Dublin, Ireland.
There is growing awareness that primary gastrointestinal pathology may play an important role in the inception and clinical expression of some childhood developmental disorders, including autism. In addition to frequent gastrointestinal symptoms, children with autism often manifest complex biochemical and immunological abnormalities. The gut-brain axis is central to certain encephalopathies of extra-cranial origin, hepatic encephalopathy being the best characterized. Commonalities in the clinical characteristics of hepatic encephalopathy and a form of autism associated with developmental regression in an apparently previously normal child, accompanied by immune-mediated gastrointestinal pathology, have led to the proposal that there may be analogous mechanisms of toxic encephalopathy in patients with liver failure and some children with autism. Aberrations in opioid biochemistry are common to these two conditions, and there is evidence that opioid peptides may mediate certain aspects of the respective syndromes. The generation of plausible and testable hypotheses in this area may help to identify new treatment options in encephalopathies of extra-cranial origin. Therapeutic targets for this autistic phenotype may include: modification of diet and entero-colonic microbial milieu in order to reduce toxin substrates, improve nutritional status and modify mucosal immunity; anti-inflammatory/immunomodulatory therapy; and specific treatment of dysmotility, focusing, for example, on the pharmacology of local opioid activity in the gut.
PMID: 11929383 [PubMed - as supplied by publisher]
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