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Wiley InterScience

The American Journal of Gastroenterology

The American Journal of Gastroenterology

Volume 99 Issue 4, Pages 598 - 605

Published Online: 7 Apr 2004

© 2008 American College of Gastroenterology/Blackwell Publishing



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Focal-Enhanced Gastritis in Regressive Autism with Features Distinct from Crohn's and Helicobacter Pylori Gastritis
Franco Torrente, M.D., Andrew Anthony, M.R.C.Path., Robert B. Heuschkel, M.R.C.P., Michael A. Thomson, M.D., F.R.C.P., Paul Ashwood, Ph.D., and Simon H. Murch, F.R.C.P.
 The Centre for Paediatric Gastroenterology, Department of Histopathology, Royal Free & University College Medical School, London
  Reprint requests and correspondence: Simon Murch, Ph.D., F.R.C.P., F.R.C.P.C.H., Centre for Paediatric Gastroenterology, Royal Free and University College School of Medicine (Royal Free Campus), Rowland Hill Street, London NW3 2PF.
Copyright 2004 by the Am. Coll. of Gastroenterology

ABSTRACT

BACKGROUND:  Immunohistochemistry allowed recent recognition of a distinct focal gastritis in Crohn's disease. Following reports of lymphocytic colitis and small bowel enteropathy in children with regressive autism, we aimed to see whether similar changes were seen in the stomach. We thus studied gastric antral biopsies in 25 affected children, in comparison to 10 with Crohn's disease, 10 with Helicobacter pylori infection, and 10 histologically normal controls. All autistic, Crohn's, and normal patients were H. pylori negative.

METHODS:  Snap-frozen antral biopsies were stained for CD3, CD4, CD8, γδ T cells, HLA-DR, IgG, heparan sulphate proteoglycan, IgM, IgA, and C1q. Cell proliferation was assessed with Ki67.

RESULTS:  Distinct patterns of gastritis were seen in the disease states: diffuse, predominantly CD4+ infiltration in H. pylori, and focal-enhanced gastritis in Crohn's disease and autism, the latter distinguished by striking dominance of CD8+ cells, together with increased intraepithelial lymphocytes in surface, foveolar and glandular epithelium. Proliferation of foveolar epithelium was similarly increased in autism, Crohn's disease and H. pylori compared to controls. A striking finding, seen only in 20/25 autistic children, was colocalized deposition of IgG and C1q on the subepithelial basement membrane and the surface epithelium.

CONCLUSIONS:  These findings demonstrate a focal CD8-dominated gastritis in autistic children, with novel features. The lesion is distinct from the recently recognized focal gastritis of Crohn's disease, which is not CD8-dominated. As in the small intestine, there is epithelial deposition of IgG.


Received.....; accepted.....

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1572-0241.2004.04142.x About DOI

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