COMMITTEE ON GOVERNMENT REFORM
2157 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, DC 20515
June 19, 2002
Arthur Krigsman MD
Mr. Chairman and members of the committee:
This testimony represents the scientific findings of
data accumulated over the past year and a half from
autistic children during the course of standard
evaluations of their gastrointestinal symptoms. This
testimony should in no way be taken as anti-vaccine.
Children in my pediatric practice continue to receive
all vaccinations in accordance with the guidelines set
forth by the American Academy of Pediatrics. The
observations expressed herein are my own, and do not
represent the opinions of any institution, organization,
clinic, or medical practice with which I may be
My involvement with autistic children began
approximately one and a half years ago. At that time, I
was approached by a colleague who was caring for a large
number of autistic patients. He observed that a large
proportion of these patients suffered from chronic,
unexplained gastrointestinal symptoms and that these
symptoms were a source of great anxiety to the parents.
I agreed to evaluate them, and my findings are detailed
below. The evaluations undertaken were standard
“textbook” evaluations of children with chronic
diarrhea, constipation, and abdominal pain, uninfluenced
by the fact that these children were autistic.
Our experience consists of a total of 43 consecutive
children aged 2-10 years of age. Most were referred by
private practitioners but many were self referred after
much frustration with their children’s ongoing
discomfort. 42 patients had received a diagnosis of
either autistic disorder or autistic spectrum disorder
by a pediatric neurologist or developmental
pediatrician. Many children had received independent
confirmation from a second or even a third pediatric
specialist. In no instance was the diagnosis disputed by
a second specialist. The remaining patient carried a
diagnosis of Aspergers syndrome.
The majority of patients had a clear history of
developmental regression. Specifically, these children
developed in an entirely normal fashion for the first
12-18 months. They typically had a vocabulary of 15-25
words, maintained normal eye contact, were playful and
interactive, and were not overly irritable. At some
point during this age interval of 12-18 months, they had
either a precipitous or gradual decline in all the above
mentioned developmental markers, and this was
accompanied by the appearance of typical autistic
behaviors, “stimming”, and bouts of unexplained
irritability. In some patients, verbal stagnation, but
not regression occurred. However, in these patients,
clear regression was seen in the interactive and social
skills of the children.
The majority of patients are from the northeastern
United States. The ratio of males to females was 7:1.
The most common gastrointestinal symptom noted by the
parents was diarrhea. In some children, the diarrhea
took the form of a soupy liquid that occurred 4 to 7
times per day and would frequently leak from the
child’s diaper. However, the majority of parents
reported a stool frequency of 1-3 per day with a
consistency of mashed potatoes. The stool is
particularly malodorous, and usually contains pieces of
undigested foods. Irritability is often noted just prior
to the bowel movement.
Constipation is another frequent complaint,
consisting of bowel movements every 3-6 days and
typically accompanied by great irritability upon passage
of the stool. The consistency of the passed stool was
not overly hard, suggesting that these children are
actually withholding stool and not truly constipated in
the strict sense of the term. This constipation is often
accompanied by abdominal distension and flatulence. Most
patients experienced periods of diarrhea alternating
with periods of constipation.
Abdominal pain is another frequent complaint. Most of
these children are poorly communicative, and parents
often rely on body language cues in determining that
their child is experiencing abdominal pain. Children
often drop unexpectedly to the floor howling and
screaming. This often lasts for up to half an hour. Many
children clutch their abdomen and bend over. Some assume
a fetal position on the bed or floor, and others take
the parents hand and rub their abdomen.
Finally, we have noticed that most regressive
autistic children show poor growth, with the majority
falling in the lower 10th %tile weight for age.
Interestingly, there does not seem to be a concomitant
percentile deficit in height for age.
All children underwent initial evaluation of their
gastrointestinal symptoms. This included a thorough
history and physical exam, complete blood count with
platelets, erythrocyte sedimentation rate, serum
chemistries, celiac antibody panel with serum IgA,
inflammatory bowel disease serology, and stool
examination for ova and parasites, culture, and occult
blood. The patients diet was thoroughly reviewed to
assure that it did not contain excessive nonabsorbed
carbohydrates or fruit juices. Therapeutic alterations
in the diet were undertaken, including the removal of
all gluten and casein containing foods. Medications and
supplements were reviewed to assure that they did not
contribute to the symptoms.
The evaluation above invariably did not lead to a
diagnosis and patients then underwent colonoscopy. Upper
endoscopy was performed only if pain was a predominant
complaint or if celiac disease was strongly suspected.
The above images depict the terminal ileum in two
patients. They are representative of the gross
endoscopic findings of 90% of these patients in whom the
lymphoid nodules of the terminal ileum were found to be
markedly enlarged. This is in agreement with the
previously published findings of Dr. Wakefield in which
a similar proportion of patients were found to have
abnormal lymphonodular hyperplasia of the terminal
The second significant finding in our series was on
histologic evaluation of the biopsy specimens. The
results are summarized below.
% patients with colitis
% patients with active colitis
% patients with chronic colitis
% patients with eosinophilic colitis
% LNH (macro) of terminal ileum
% neither active, chronic, nor eosinophilic
Colitis was determined as per the report of the
institutional pathologist. The interpretation of whether
the degree of inflammation represented true pathologic
inflammation versus a normal variant was subject to the
personal experience of the individual pathologist and
was not subjected to a uniform rating system.
The patterns of inflammation were patchy and
unpredictable in any given patient, but overall were
noted in all parts of the colon and terminal ileum.
Although the table above lists chronic and active
colitis separately, most patients with colitis had both
chronic and active inflammation. Most patients had at
least 3-4 distinct areas of histologic inflammation,
with an equal number of biopsies that were
histologically normal. The intensity of the inflammatory
lesions varied as well, with many being subtle and
somewhat focal, and others being more marked and
diffuse. The latter included areas of cryptitis, crypt
abscess, ulcerations, and dense inflammatory
infiltration. One patient was found to have an
inflammatory polyp. Most significantly, these findings
were consistent and seen repeatedly amongst the majority
In regards to the last group of patients in the table
above, it should be noted that although the histology
did not reveal pathologic colonic inflammation, the
majority of these patients were found to have a heavy
and diffuse lymphoid hyperplasia of the colon
(macroscopic and microscopic), signifying an activation
of the colon’s internal immune system.
In a series of 43 autistic children, mostly
regressive, with chronic gastrointestinal symptoms, the
majority were found to have pathologic inflammation of
the colon and terminal ileum. 90% had pathologic
lymphonodular hyperplasia of the terminal ileum.
Moreover, the findings were similar and consistent from
patient to patient within the affected group.
1) Does autistic colitis occur equally in regressive
vs. non-regressive autism?
2) Do differences in growth exist between the colitis
and non-colitis group?
3) Do differences in growth exist between the
regressive vs. non-regressive group?
4) In a retrospective analysis of growth, will onset
of growth failure coincide with the onset of regressive
experts back MMR doctor's findings
The man whose research first raised
concern over the vaccine's safety is winning support.
Lorraine Fraser reports from an influential
Scientists in America have reported the
first independent corroboration of the research findings
of Dr Andrew Wakefield, the
specialist who has questioned the safety of the
childhood MMR vaccine.
Dr Arthur Krigsman, from New York
University School of Medicine, has observed serious
intestinal inflammation in autistic children identical
to that described by the controversial British doctor
and his colleagues in a research paper four years ago.
Dr Krigsman's discovery is significant
because it independently supports Dr Wakefield's
conclusion that a previously unidentified and
devastating combination of bowel and brain disease is
afflicting young children - a claim that the Department
of Health has dismissed as "bad science".
Dr Wakefield has seen nearly 200
previously normal youngsters who apparently developed
the combined behaviour and digestive problems after
receiving the three-in-one measles, mumps and rubella
jab - a vaccination given routinely to babies and
pre-school children in Britain and the United States.
Pathologists at Trinity College,
Dublin, have since identified measles virus in bowel
tissue samples from 75 of these children and, as
reported in The Telegraph last week, now claim to
have evidence that the virus comes from MMR.
The Department of Health refuses to
accept that such results cast doubt on MMR's safety. A
principal criticism levelled at Dr Wakefield and his
colleagues is that no part of their research has been
replicated by scientists elsewhere.
Last Wednesday, however, Dr Krigsman
reported that he had seen the same pattern of illness in
43 American children.
At a hearing of the Government Reform
Committee of the United States Congress on the safety of
MMR and other vaccines, he said that - like the British
children - his patients had all inexplicably
deteriorated, losing language and other skills, at
around 12 to 18 months of age.
All the children had a definite
diagnosis of autism and had come to him because they had
symptoms of serious digestive problems, such as pain,
constipation and diarrhoea, for which no explanation
could be found.
"Our findings, which are
independent of Dr Wakefield's findings, completely
support his explanation and his observations of the
abnormalities in the bowels of these children," he
The intestines of the children were
"not normal", he added. One 13-year-old
autistic boy, who had become so violent that his parents
had wanted to institutionalise him, had the "worst
case" of inflammation of the colon the doctor had
ever seen through a fibre-optic scope.
Dr Krigsman, an experienced consultant
paediatric gastroenterologist and an assistant professor
at the university, told the committee that he did not
know whether his patients' illnesses were linked to MMR.
However, he now plans to have the biopsies he took
during the examinations tested independently to check
for evidence of measles virus infection.
The results will be awaited anxiously
by parents and public health officials in Britain, where
debate over the safety of MMR began with the report from
Dr Wakefield and other doctors at the Royal Free
Hospital in north London in 1998.
Dr Krigsman's research was among
presentations described as "significant
findings" by Dan Burton, an Indiana congressman
chairing the Congressional committee.
Doctors in Britain and America are
recognising more autistic children than ever. The US
National Institute of Health estimates that one American
child in 250 is affected, compared with one in 10,000 a
decade ago. A recent survey by the National Autistic
Society in England suggested that one in 86 primary
school pupils may have the condition.
Health officials in both countries
insist, however, that there is no evidence to link this
apparent increase with the use of MMR or any other
vaccine, and say there is no reason for parents to
worry. In Britain, the Department of Health has rejected
calls to allow single measles vaccines on the NHS as an
alternative, claiming that numerous statistical studies
have concluded that MMR is safe.
The Congressional committee heard
evidence from other specialists suggesting that MMR and
the mercury-based preservative, Thimerosal, may both
harm susceptible children, possibly by altering their
immune system. Thimerosal is not used in MMR, but is
contained in other childhood jabs such as DTP - the
diphtheria, tetanus and whooping-cough vaccine.
Dr Jeff Bradstreet, the medical
director of the International Child Development Resource
Centre in Florida, disclosed that tests on his
eight-year-old autistic son Matthew - who received
vaccines containing mercury and the MMR jab - have found
particles of measles virus in the fluid that bathes his
brain and spine as well as in his intestines.
Two other boys with autism who, like
Matthew, have recently started to suffer seizures, also
have measles virus in their cerebrospinal fluid.
While the significance of this is not
yet clear, Dr Bradstreet said he was broadening his
research in this area.