Tuesday, February 2, 2010

Some thoughts on Arthur Krigsman's newst study.

I finally got to reading Dr.Arthur Krigsman's article published last week,"Clinical Presentation and Histologic Findings at Ileocolonoscopy in Children with Autistic Spectrum Disorder and Chronic Gastrointestinal Symptoms",and right away,there were a copule of things,I was ready to applaud.First,the fact he had included at least one patient in the study,who was as old as 36 years old.Secondly the realization,that changing the diet has no effect at all on severity of GI pain,something that I have been trying to tell people for years,and that neither parents or doctors seem to get.



Abdominal pain was easily determined in patients able to articulate
discomfort.In non-verbal patients,abdominal pain was indicated by
frequent,unexplained excessive irritability, awakening from sleep in a state of
unusual irritability or agitation, and uncharacteristic aggression.1 “Pain
posturing”,in which the child assumes a leaning position, providing direct
pressure to the lower abdomen, is a clinically accepted pain indication in this
population and parents were specifically asked about this.While initial patient
evaluation included a dietary history to explore the possibility of food allergy,this was not a common finding. However, in virtually every case, foods causing non-IgE mediated GI symptoms were avoided for 6-months prior to endoscopic examination.





In all cases, dietary interventions/restrictions did not significantly improve gastrointestinal symptomatology and initial laboratory evaluation did not provide an etiologic diagnosis.



I was more than a little ticked off.Krigsman,et al admitted that there was serious pain going on here,but they seemed to offer nothing as far as treatment or management of this pain was concerned.GI pain was something I brought up,the last time I saw my DAN! doctor.His only suggestion was that I try to get medical marijuana,which I am seriously looking into,but I neither have the money for it,nor meet the State of New Mexico's official criteria for it.Like so many with autism,my blood tests have never quite made it for a Crohn's diagnosis.

I then saw that they had used ileocolonoscopy to examine the patients, something no doctor was ever willing to do for me.





Of the 83 patients presenting with diarrhea without constipation, data on
ileal and colonic inflammation was available for 74. Of these, 59 (79.7%) had
inflammation in either the ileum, the colon or both locations. An additional 6
patients who presented with diarrhea but for whom ileal intubation was not
successful, had colonic inflammation, while 3 did not.For patients presenting
with diarrhea therefore,the estimate of prevalence of inflammation is between
65/83 and 68/83 (78.3%–81.9%). Data on ileal and colonic inflammation was
available on 19 patients presenting with constipation without associated
diarrhea.Of these, 12 (63.2%) had ileal or colonic inflammation.3 patients for
whom ileal intubation was not successful presented with diarrhea. All 3 had
colonic inflammation. This allows a more definitive estimate of overall
prevalence of inflammation in this group.Of the 22 patients presenting with
constipation alone,15 (68.1%) had ileal or colonic inflammation.

.

It then talks about ileo-colonic lymphoid-nodular hypoplasia,something I was found to have years ago,but nobody seemed to think was all that important.

My problem with this,is most of the literature on this,seems to come from Andrew Wakefield, and nobody else seems to want to study it much.

So the conclusion he comes to is this:



This study confirms earlier reports of a non-specific (non-Crohn’s disease, non-ulcerative colitis) mucosal histopathology in ASD patients with chronic gastrointestinal symptoms....It appears that the immunologic and inflammatory
activity in the bowel is part of a larger, systemic multi-organ immunopathology.
...While ileocolonic LNH has long been thought of as a ‘normal’ pediatric
variant commonly encountered in developmentally normal children undergoing
ileocolonoscopy, it is also a prominent component of the inflammatory response
in gastrointestinal infectious processes such as H. pylori gastritis,
Shigellosis,C. difficile colitis, and yersiniosis, among others.


The origin of the ileocolonic pathology is unknown.The pattern of inflammation may represent autoimmune disease,chronic infectious enterocolitis, food sensitivity/ allergy, or a combination of the above.Because virtually all patients were on some form of a symptom based restricted diet, the impact of specific dietary factors on symptoms and histopathology could not be evaluated in this study.


In short,we have no idea what the f**k is going on,and no way to treat it.

Well,the two things that stuck out in my mind were all the attention paid to the ileum,and this business about a "a larger, systemic multi-organ immunopathology".I may be all wet on this,but I have an interesting theory.What if the GI disease is all secondary to a genetic methylation disorder,or something related to MB12 deficiency,or metabolism? MB12 is metabolised in the ileum after all.The article did not mention if any of the people in the study were tested for megaloblastic anemia or folate metabolism disorders or not,but I wonder if this could not be the cause.


Megaloblastosis is a generalized disorder because nonhematopoietic cells, such as GASTROINTESTINAL and uterine cervical mucosal cells, can also have megaloblastic features. The etiology of megaloblastic anemias is diverse, but a common basis is impaired DNA synthesis. The most common causes of megaloblastosis are cobalamin (vitamin B-12) and folate deficiencies. The usual causes of cobalamin deficiency are pernicious anemia (PA, see Pernicious Anemia), failure of absorption of cobalamin in the terminal ileum...




I also wonder if the underlying GI,and immune issues so many of us with autism,and MTHFR problems have may be due to an unknown "new" condition originating in the
bone
marrow.

All this requires is an ability to look beyond vaccines as the possible cause for all this crap,yes crap.Open your minds,and you open yourself to all sorts of possibilties.



Has Krigsman,though,that is the question.While he is to be commended for not mentioning vaccines or MMR once,his past precedes him.I am no fan of case/autism/quackwatch,any more than I am of David Gorski,but his name on the study does raise all sorts problems.Especially for more mainstream doctors who want to take this stuff seriously.I would assume he still believes all this about vaccines,and thimerosol,since he has made no public statement otherwise.

Everybody at Thoughtful House seems to have a dark cloud over them, even though they are clearly doing some very important work.Perhaps they ought to let somebody else do some of this work for a while,someone who isn't tainted by all this vaccine stuff,and can look at things more objectively,and investigate other causes for these conditions.

Don't forget,I've lived with the GI disease of autism myself for almost fifty years.As a child/teenager, I had to go to the ER fo severe impaction more than once.The food reactions of head banging, severe stimming,and rages,with the acute malabsorption that follows it is something I know personally all too well.I've been through it all.Nobody wants to find an answer more than I do,but perhaps by allowing those who believe vaccines are the cause for it all,to do most of the research,we will never get to the real answers after all.

1 comment:

  1. Do vaccines cause all the gastro problems-not likely.
    Do they cause some-definitely.

    Stop apologizing for the damn vaccines-they are destroying the human race, and quite frankly you sound like you know it but are afraid of the repercussions of stating it outright.

    ReplyDelete