This post is all about those stomach problems typical of many kids with ASD and some of their neuro-typical close relatives. Since Monty, aged 10 with ASD, does not have any of these problems, it is not something I have looked into earlier. As you will see later in this post, by understanding the underlying science, we can move another step towards inhibiting systemic inflammation, which affects all people with ASD.
Irritable
bowel syndrome (IBS) and Inflammatory Bowel Disease (IBD),
First of all
we need to differentiate two common conditions with very similar symptoms. IBS is the less serious condition, though it causes
lots of discomfort.
Irritable Bowel syndrome - IBS
Irritable bowel syndrome (IBS)
sufferers show no sign of disease or abnormalities when the colon is examined.
IBS does not produce the
destructive inflammation found in IBD. It does not result in permanent harm to
the intestines, intestinal bleeding, or the harmful complications often
occurring with IBD. People with IBS are not at higher risk for colon cancer,
nor are they more likely to develop IBD or other gastrointestinal diseases
The exact cause of IBS is unknown. The
most common theory is that IBS is a disorder of the interaction between the
brain and the gastrointestinal tract, although there may
also be abnormalities in the gut flora and immune system.
Inflammatory Bowel Disease - IBD
Inflammatory bowel disease is a
group of inflammatory conditions of the colon
and small intestine. The major types of IBD are Crohn's
disease and ulcerative colitis
Crohn’s
disease has a strong genetic component and is far more prevalent among smokers. The usual onset is between 15 and 30 years
old.
Ulcerative
colitis is an auto-immune disease with no known cause. The symptoms are very similar to Crohn’s
disease, but there are some stark differences. Ulcerative colitis is far less prevalent among smokers
Autistic Colitis / Ulcerative Colitis
The
Inflammatory Bowel Disease (IBD) that seems to be relevant in Autism is
ulcerative colitis, so much so that Wakefield and Krigsman sought to name a
sub-type Autistic Enterocolitis. Due to
all the furore about vaccinations and autism, the research of these two gastroenterologists
has been blacklisted.
Dr Krigsman
has an informative website and has published some interesting research.
If you spend
all day looking via the endoscope at
children with ASD, you are bound to notice a thing or two. Ignoring what Krigsman observes is bizarre.
In case you
are wondering what he does, he is going through the mouth to do an Upper Endoscopy; for the Colonoscopy
he goes in from below. He does both
procedures under general anaesthetic. That
will be painless; I once had an endoscopy under general anaesthetic and you have no bad
effects. I had the misfortune to have
another one without any anaesthetic,
which was one of the most unpleasant experiences of my life.
Ulcerative
colitis looks like a nasty condition but Krigsman finds it is generally treatable
with some combination of
anti-inflammatory medication, antimicrobials, probiotics, digestive enzymes and
dietary restriction.
One thing he
does not mention is nicotine, more of that later.
GERD
Gastroesophageal reflux disease (GERD) is a very common disease. The acid within the stomach rises up into the
esophagus and in doing so, damages its lining.
Most children will outgrow their reflux by their first
birthday. However, a small but significant number of them will not outgrow the
condition. This is particularly true when a family history of GERD is present. It is
estimated that 15% of adults of adults are affected by GERD.
Krigsman
find that in kids with ASD and their siblings, GERD is relatively common.
Mechanisms linking IBS and IBD to
Autism
I have already
written about the link between food allergies, autism and behaviour. In those posts it was histamine released from
mast cells (along with cytokines and other nasties) that was the culprit. The treatments included antihistamines and
mast cell stabilizers (Ketotifen, Intal etc).
I would presume this would fall into the IBS category.
When it
comes to IBD, things get interesting.
In 1936 the
Nobel Prize for Physiology was awarded to Sir Henry Dale and Otto Loewi. One had identified the neurotransmitter acetylcholine
and the other had shown how the vagus nerve releases acetylcholine to control heartbeat.
It later became apparent how
important the vagus nerve is. The vagus nerve is a modulator of inflammation throughout
the body. Acetylcholine, the principle neurotransmitter released by the
vagus nerve, can exert its anti-inflammatory effect via binding to nicotinic
acetylcholine receptors (nAChRs), which are expressed on macrophages and other
immune cells.
In a recent post I showed that autistic brain samples have diminished acetylcholine and nicotinic receptor activity. I showed how this could be corrected either by drugs that mimic acetylcholine (eg nicotine or acetylcholine) or with an acetylcholinesterase inhibitor (Galantamine or Donepezil).
I found it
very interesting that IBD can be successfully treated by mild smoking (3
cigarettes a day) or with nicotine patches.
This then
connects various comorbidities in a very useful way and opens up therapeutic directions. The vagus nerve is also key to epilepsy. Vagus nerve stimulation is currently used to
treat epilepsy and depression.
Experimentally,
vagus nerve stimulation is already used in autism.
CONCLUSIONS:
Patients with ASD and intractable
epilepsy respond as favorably as all other patients receiving VNS therapy. In
addition, they may experience a number of QOL improvements, some of which
exceed those classically observed following placement of a VNS device.
Kevin J. Tracey
A neurosurgeon and inventor, Kevin Tracey, is the man behind
the inflammatory reflex. The inflammatory reflex is a neural
circuit that regulates the immune response to injury and invasion. All reflexes
have an afferent and efferent arc. The Inflammatory reflex has a
sensory, afferent arc, which is activated by cytokines, and a motor, or
efferent arc, which transmits action potentials in the vagus nerve to suppress
cytokine production. Increased signaling in the efferent arc inhibits
inflammation and prevents organ damage.
We will be looking at his research and the Cholinergic anti-inflammatory
pathway, in later posts