Gastrointestinal disturbances and immune response to gluten in pervasive developmental disorders

الملخص EN

Objectives: Gastrointestinal symptoms are a common feature in children with pervasive developmental disorders, drawing attention to a potential association with celiac disease or gluten sensitivity.

However, studies to date regarding the immune response to gluten in Pervasive Developmental disorders and its association with celiac disease have been inconsistent.

Subjects and Methods: This cross sectional case control study included 45 patients aged 3 to 12 years (with or without gastrointestinal symptoms) diagnosed with Pervasive Developmental Disorders according to DSM- IV TR, Childhood Autism Rating Scale (CARS) and Gallium test for autistic characters.

EEG was done to diagnose epilepsy.

They had been regularly attending out patient clinic of center for care of children with special needs, institute of postgraduate childhood studies; Ain shams University, Egypt for at least one year.

Forty five apparently healthy children of matched age and sex were recruited as a control group.

Serum levels of IgG, IgA, IgM class antibodies to gliadin were measured by using ELISA methods.

Results: A total of forty five autistic children with confirmed diagnosis aged between 3 to 12 years were studied.

They were 36 males and 9 females with male to female ratio 3.5:1.

The mean age of introduction to cereals was 6 months (range 4- 8 months).

The main gastrointestinal symptoms as abdominal distension was present in 20 patients (44.4%), constipation in 16 patients (35.6%), chronic diarrhea in 8 patients (17.8%), vomiting in 9 patients (20%), anorexia in 19 patients (42.2%), iron- deficiency anemia that does not respond to iron therapy in 24 patients (53.3%), feeding difficulties in 10 patients (22.2%).

None of the autistics examined were positive for IgA and IgG antibodies tested, and 60% patients showed high serum levels of IgM antibodies to gliadin.

Conclusion: The increased anti- gliadin antibody response and its association with GI symptoms points to a potential mechanism involving immunologic and/or intestinal permeability abnormalities in affected children.

Immunological detection of, IgA, IgM and IgG antibodies class to gliadin are useful tool in the diagnosis and follow* up of the disease.