HLA-DQ Genotyping, Duodenal Histology, and Response to Exclusion Diet in Autistic Children With Gastrointestinal Symptoms.

OBJECTIVES: A correlation between autism spectrum disorders (ASDs) and gastrointestinal (GI) problems, and a possible link between gluten consumption and ASD have been increasingly reported. Gluten/casein-free diet (GCFD) is often undertaken, with conflicting results. This study aimed at evaluating the distribution of human leukocyte antigen (HLA)-DQ2/DQ8 typing among patients with ASD with GI symptoms, together with its correlation with duodenal histology and response to GCFD. METHODS: Between 2002 and 2015 all patients with ASD with GI symptoms referred to our outpatient clinic, displaying clinical, laboratory, or ultrasound findings suggestive of organic disease, underwent endoscopy, celiac disease (CD) serum antibodies testing and HLA-DQ2/DQ8 genotyping. Patients were prescribed a 6-month GCFD, and then clinically reassessed. RESULTS: Among 151 enrolled patients, 134 (89%) were negative for CD-specific antibodies; 72 (48%) were positive for HLA-DQ2/DQ8; and 56 (37%) showed duodenal microscopic inflammation. Clinical improvement was observed in non-CD patients irrespective of the rigorous or partial adherence to the diet, being the difference nonstatistically significant. Response to diet was related to the presence of histological duodenal alterations at baseline (odds ratio 11.323, 95% confidence interval 1.386-92.549 for Marsh 2 pattern), but not to HLA-DQ2/DQ8 positivity (odds ratio 1.120, 95% confidence interval 0.462-2.716). CONCLUSIONS: Our data suggest that children with ASD with GI symptoms have a high prevalence of duodenal intraepithelial lymphocytic infiltration, which seems to be linked to a mechanism other than autoimmune response to gluten consumption. Alteration of duodenal histology, but not the HLA-DQ2/DQ8 status, was associated with clinical response to the diet.

Diffuse gastroduodenitis associated with ulcerative colitis: treatment by infliximab.

Diffuse gastroduodenitis resembling ulcerative colitis in respect to macro- and microscopic findings occurs in ulcerative colitis, although it is rare. Reports of gastroduodenitis associated with ulcerative colitis treated with infliximab are rare. A 58-year-old man had tarry stool in March 2011. He had a history of ulcerative colitis that was diagnosed in 1984. He underwent subtotal colectomy in 1991. Endoscopy and radiography revealed diffuse friable mucosa throughout the duodenum and an ulcer in the middle of the descending portion, resulting in a narrow portion.In the stomach, numerous small aphthae were observed in the antrum. Biopsy specimens of the duodenum and antrum showed marked inflammatory cell infiltration in both areas and cryptitis in the duodenum. Standard induction therapy of infliximab was started in April. The ulcer in the descending portion became a scar without diffuse mucosal friability in September 2011.

[Soy products for dietary treatment of children with erosive-ulcerative lesions of the alimentary tract].

The usage of soy products for dietary treatment of children with erosive-ulcer lesions of alimentary tract brings positive clinical dynamics, normalization of colon function and protein metabolism, acceleration of erosive defects repair, immune status correction. The obtained results justify inclusion of soy products into duodenal pathology treatment--especially when accompanied by protein deficiency.

Cows milk protein enteropathy and granulomatous duodenitis in a newborn.

Cow's milk protein enteropathy is a symptom complex that composed of severe diarrhoea and malnutrition. This disorder is caused by non-immunoglobulin E-mediated food allergy. Its clinical features and natural course have been explained in many reports, of different types of cow's milk and soy reactions. In the present article, we describe a newborn patient who presented with chronic diarrhoea and failure to thrive diagnosed as cow's milk protein enteropathy. The duodenal biopsy revealed granulomatous duodenitis which has not been described before. Her clinical and pathological findings responded well to cow's milk elimination. We suggest that food allergies should be considered in differential diagnosis of patients with chronic diarrhoea and failure to thrive.

[Ventramine and lipid peroxidation in children with erosive gastroduodenitis].

43 patients and 20 healthy children, aged 11-15, were examined. Increased contents of primary, secondary, intermediary and final products of lipid peroxidation (LPO) in serum lipids as well as an intensified antioxidant activity were registered in children with erosive gastroduodenitis. Ventramine, when used in the treatment of erosive gastroduodenitis in children, arrests rapidly the clinical signs of the disease and normalizes LPO.

[Substantiation of the need of fortification with vitamins of the diet of children with gastrointestinal diseases]. / Obosnovanie neobkhodimosti obogashcheniia vitaminami ratsiona detei s zabolevaniiami zheludochno-kishechnogo trakta.

Surveys of 28 children have shown that 64 per cent of the children suffering from ulcerous disease of the stomach and the duodemun or chronic duodenitis have a combined deficiency of vitamin E, vitamins of the B group and beta-carotene. Diet No. 1 and No. 5 could not provide daily needs for vitamins. The patients were found to have a lower antioxidant activity of the blood serum, whereas the contents of hydroperoxides, double bonds and malonic dialdehydes were higher than in healthy children. The POL index in children with high beta-carotene deficiency was significantly higher than that in ailing children supplied with this carotenoid. Correlation analysis has revealed a reverse relationship between concentration of vitamin E and beta-carotene in blood serum and POL products, i.e. the better a child is supplied with these vitamins, the lower is the level of POL products. When the drink with the whole set of vitamins and an oil solution of beta-carotene was included in the diet of the children, it was found that hypovitaminosis frequency lowered with positive effects on their clinical condition and improved POL indexes. So there is a reason to fortify diets of children suffering from gastrointestinal disorders with vitamins-antioxidants.

[The reducing-diet therapy of chronic lesions of the gastroduodenal area]. / Rozvantazhuval'no-diietychna terapiia khronichnykh urazhen' hastroduodenal'noï zony.

The author summarizes the experience of UDT in 140 patients with chronic gastritis (53) and gastroduodenitis (87) and 46 with duodenal ulcer. It was found that chronic diseases of the gastroduodenal zone were characterized by changes in the hematological and biochemical indices of the blood against the background of altered immune reactivity and that UDT favoured their normalization.

[Protective properties of moose's milk and perspectives of its use in pediatric gastroenterology]. / Zashchitnye svoistva losinogo moloka i perspektiva ego ispozovaniia v detskoi gastroénterologii.

The authors studied microbe dissemination, lysozyme activity and antacid properties in some samples of native, pasteurized and boiled moose's milk. A relationship was demonstrated between the buffer properties of moose's milk and its lysozyme activity. It is advisable that moose's milk be used in combined therapy and for prevention of gastroenterologic diseases in children.

[Impairment of the acetylating function of the liver and indicators of digestion in children with gastroduodenal and biliary pathology]. / Rasstroistva atsetiliruiushchei funktsii pecheni i pokazateli polostnogo pishchevareniia u detei s gastroduodenaobiliarnoi patologiei.

Processes of acetylation and parameters of cavitary digestion were investigated in 65 children with gastroduodenobiliary diseases. The most pronounced shifts of all the parameters studied were recorded in patients with chronic gastroduodenitis attended by metabolic dyskinesia of the biliary tract. A combination of vitamins was tested that produces protective effect on the acetylation system in the liver.

[Effect of a "green" diet on various clinical and metabolic indicators in patients with gastrointestinal diseases]. / Vliianie "diety s zelen'iu" na nekotorye klinicheskie i obmennye pokazateli u bol'nykh s gastrointestinal'nymi zabolevaniiami.

The authors recommend that patients with all chronic diseases of the alimentary organs, particularly with colonic function abnormalities should receive, with the exception of patients with disease exacerbations, salads from raw vegetables (100 g 3 times a day) before meal being a constituent part of the balanced diet. The diet containing salad from raw vegetables was received by 93 inpatients with different chronic diseases of the alimentary tract, gastroduodenal ulcer included. The patients did not exhibit intolerance provided the salad was made properly. Pain and meteorism disappeared or were relieved, intestinal evacuation returned to normal in the majority of patients.