Beneficial behavioural effects of IBD therapy and gluten/casein-free diet in an Italian cohort of patients with autistic enterocolitis followed over one year

Autism diagnoses alone have risen from 1:5000 in 1980 to a frightening 1:120 today, that cannot only be the result of better diagnostic variation or recognition of the disease. A substantial proportion of pts with regressive/late onset autism showed evidence of a previously unrecognized IBD, labelled autistic enterocolitis characterized by lymphoid nodular hyperplasia and chronic ileo-colitis. Although improvements in autistic behaviour has been reported when gluten and casein exclusion diets was introduced, no data is available on the effect of specific bowel therapy on the psychiatric symptoms. We aimed to evaluate the effects of specific IBD therapy together with the gluten/casein free diet on specific gastrointestinal and autistic symptoms in a cohort of regressive/late onset autistic pts with autistic enterocolitis, followed over 12 months. Among the 85 consecutive autistic pts observed, 40 presented with severe constipation or diarrhoea. In 12 of them (male, median age 16 yrs, 4-30) an endoscopy and wireless capsule examination were performed because of the permission of the parents and then enrolled in the follow-up study. Macroscopic lesions were observed in 55% of the pts in both the upper and lower gastrointestinal tract. Microscopic involvement was observed in 70%, 60% and in 100% of pts in the upper gastrointestinal tract, in the terminal ileum and in the colon respectively, with different histological grade. Mesalazine (8 pts), steroids (2 pts) and 6-mercaptopurine (2 pts) were prescribed according to the histological/clinical score. Casein-free diet and successively glutein-free diet were introduced within the first 3 months by a dietician. A Behavioural Summarized Evaluation (BSE, a score with 29 behavioural items with a degree of frequency validated with a statistical correlation with the Childhood Autism Rating Scale) was used to blindly evaluate the pts at entrance and after 12 months. After 1 year treatment, 80% of pts with severe constipation or diarrhoea had normal stool movements and in 75% an evident reduction of abdominal pain was also observed. The total BSE score showed a global improvement after 12 months that ranged from 10 to 32% (p=0.00388) in all the pts evaluated. When selected symptoms were compared before and after the treatment a reduction of deep anxiety (53%), agitation (35%), mood disturbance (24%), etero-aggressivity (14%), self-aggressivity (13%) as well as an improvement of attention (77%) and sleep (44%) were also observed (p=0.009796). In conclusion, these results proved for the first time a beneficial effect of the combination of drug and dietetic therapy on both bowel and psychiatric symptoms in autism.