Celiac.com 02/26/2024 - A recent study, conducted by researchers Bodil Roth and Bodil Ohlsson, sheds light on the association between celiac disease and microscopic colitis, providing valuable insights into the clinical course, and subtypes of the disease in a female population. 

Microscopic colitis is characterized by chronic inflammation of the colon, and has long been linked to autoimmune conditions, smoking, and certain medications. Their study aimed to investigate this connection, considering various subtypes of microscopic colitis and their clinical presentations.

The research, which involved 240 women aged 73 years or older diagnosed with microscopic colitis, revealed intriguing findings. Out of the 158 women who agreed to participate, half experienced the simultaneous onset of microscopic colitis and celiac disease. Notably, celiac disease was most prevalent in patients with lymphocytic colitis, with a significantly higher incidence compared to other subtypes of microscopic colitis.

Analysis of blood samples also revealed the presence of anti-transglutaminase antibodies, a marker for celiac disease, in some participants with one episode of microscopic colitis. Moreover, corticosteroid use was more common in patients with collagenous colitis and refractory microscopic colitis, highlighting the diverse clinical manifestations of the disease.

The study also explored the impact of smoking habits on the prevalence of microscopic colitis and associated symptoms. Past smokers showed a higher prevalence of one-episode microscopic colitis, while current smoking was associated with an increased likelihood of experiencing irritable bowel syndrome (IBS)-like symptoms.

Significant Association Found Between Celiac Disease and Lymphocytic Colitis

Upon adjusting for smoking habits, the researchers found a significant association between celiac disease and lymphocytic colitis, suggesting a potential link between these conditions. However, further research is needed to elucidate the nature of this relationship and whether lymphocytic colitis in conjunction with celiac disease should be classified as a distinct entity or a variant of celiac disease.

These findings underscore the complex interplay between autoimmune conditions and gastrointestinal disorders, emphasizing the importance of comprehensive clinical evaluation and tailored management approaches. As researchers continue to unravel the intricacies of these diseases, advancements in diagnosis and treatment hold promise for improving the lives of individuals affected by celiac disease and microscopic colitis.

Read more in BMC Gastroenterology volume 24, Article number: 70 (2024)

Celiac.com 06/26/2023 - Primary sclerosing cholangitis (PSC) is a progressive bile duct disease often associated with inflammatory bowel disease (IBD). Managing these conditions can be challenging, and researchers are constantly exploring new approaches to improve patient outcomes. 

A team of researchers recently set out to investigate whether patients with PSC-IBD could benefit from a gluten-free diet combined with the exclusion of amylase trypsin inhibitors (ATIs).

Study Design

The team conducted a prospective clinical pilot study on 15 patients diagnosed with PSC-inflammatory bowel disease. The participants were placed on an eight-week gluten-free diet. The study aimed to evaluate primary outcomes such as colonic inflammation, assessed through proctosigmoidoscopy, and liver stiffness, measured as a surrogate for fibrosis, inflammation, and cholestasis, using transient elastography. The researchers also examined secondary outcomes including changes in colonic mucosal and serum cytokines/chemokines, intestinal microbiome composition, transcriptome dynamics, and serum markers of hepatic fibrogenesis.

Results and Findings - Improvement in Gut Barrier Function

Although the study did not demonstrate a clinical improvement in the primary outcomes of colonic inflammation and liver stiffness, several noteworthy findings emerged. The expression of pro-inflammatory mucosal cytokines and chemokines, including IL6, IL8, CCL2, and TNFα, was significantly down-regulated. Additionally, two critical markers of liver fibrosis and matrix remodeling, thrombospondin-2 and -4, showed significant decreases.

Furthermore, the composition of the intestinal microbiota underwent slight changes, with a decrease in the pathogen Romboutsia ilealis. Analysis of the intestinal transcriptome suggested an improvement in gut barrier function. However, factors such as pruritus, fatigue, overall well-being, faecal calprotectin levels, and serum alkaline phosphatase did not exhibit significant changes.

Implications and Future Research

Although the short-term gluten-free diet did not lead to noticeable clinical improvements in patients with PSC-inflammatory bowel disease, the study revealed potential benefits. The down-regulation of pro-inflammatory cytokines and chemokines, as well as the reduction in markers associated with liver fibrosis, indicate potential for mitigating intestinal inflammation, and improving liver health.

Moreover, the slight alterations in the intestinal microbiota composition and improved gut barrier function offer further insights into the complex interplay between diet, gut health, and disease progression. 

While the findings are promising, it is important to note that this study was a pilot investigation with a small sample size. Therefore, further research with larger cohorts and longer durations is necessary to fully understand the therapeutic potential of a gluten-free diet in managing PSC-inflammatory bowel disease.

Read more in Global Pediatric Health. 2021;8.

The research team included Timur Liwinski; Sina Hübener; Lara Henze; Peter Hübener; Melina Heinemann; Marcus Tetzlaff; Marie I. Hiller; Bettina Jagemann; Rambabu Surabattula; Diana Leeming; Morten Karsdal; Erika Monguzzi; Guido Schachschal; Thomas Rösch; Corinna Bang; Andre Franke; Ansgar W. Lohse; Detlef Schuppan; and Christoph Schramm.

They are variously affiliated with the Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; the Center for Affective, Stress and Sleep Disorders (ZASS), University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland; the Institute of Translational Immunology and Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany; the Research and Development, Nordic Bioscience, Biomarkers and Research A/S, Herlev, Denmark; the Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; the Institute for Clinical Molecular Biology, Christian Albrechts University of Kiel, Kiel, Germany; the Hamburg Center for Translational Immunology, Hamburg, Germany; the Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; and the Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.  

Celiac.com 03/15/2023 - A recent study by Indiana University School of Medicine's Jonathan Montrose, DO, found that only one out of 36 patients with both celiac disease and inflammatory bowel disease (IBD) adhered to a gluten-free diet long-term. That's less than 3% of those patients following a gluten-free diet. 

According to Montrose, the lack of formal education on gluten-free diets is a factor, as only six of the 36 patients had received dietary education from a celiac dietitian. 

The majority of patients in the study were white women, and 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet. 

"Overall, our study showed that there was suboptimal adherence to gluten-free diets." Montrose and his colleagues suggested that the establishment of celiac disease centers at tertiary hospitals could be one way to address the lack of formal gluten-free diet education. 

Montrose and colleagues suggest establishing celiac disease centers at tertiary hospitals to provide adequate clinical guidance. 

Perseus Patel, MD, of the University of California San Francisco, agreed that getting adults to stick to a gluten-free diet is challenging and that more education is needed in this area. He noted that "If you go out to eat, you often don't have many choices, so it is not always the easiest thing to do."

The fact that only 3% of patients in the study followed a gluten-free diet long-term is concerning because it suggests that many patients with celiac disease and IBD may not be getting the optimal treatment they need. Furthermore, the study found that 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet, indicating that there may be other factors contributing to the management of these conditions.

The recommendation to establish celiac disease centers at tertiary hospitals is a practical solution that could improve patient outcomes by providing adequate clinical guidance and support. 

In conclusion, this study highlights the challenges of managing celiac disease and IBD, particularly in terms of adherence to a gluten-free diet. 

Healthcare professionals need to be more proactive in educating patients about the importance of a gluten-free diet. There's also a need for more resources and support for patients with these conditions. 

The establishment of celiac disease centers could be an effective way to address this issue and improve patient outcomes.

Read more at: Metpagetoday.com

Celiac.com 07/25/2022 - Celiac disease and inflammatory bowel disease share a number of factors, including some co-occurrence, independent of temporal sequence, which suggests a shared etiology. To better understand the picture, a team of researchers recently set out to determine the risk of inflammatory bowel disease (IBD) in patients with celiac disease (and vice versa) compared to matched subjects from the general-population.

The research team included Karl Mårild MD PhD; Jonas Söderling PhD; Lebwohl, Benjamin MD; Green, Peter HR MD; Pinto-Sanchez, Maria Ines MD MSc; Halfvarson, Jonas MD PhD; Bjorn Roelstraete PhD; Ola Olén MD PhD; and Jonas F. Ludvigsson MD PhD.

The researchers used the Swedish histopathology and healthcare register data to identify nearly 50,000 patients with celiac disease, along with nearly 85,000 with IBD diagnosed in 1969-2016. The team compared each patient to age- and 336 sex-matched general-population subjects with celiac disease, and 503 with IBD. They used Cox regression to estimated hazard ratios (HRs) for IBD in celiac patients and vice versa. 

To reduce potential surveillance bias, the team limited their main analyses to events beyond the first year of follow-up. Nearly eight-hundred patients were diagnosed with IBD during follow-up, compared to 1015 in the matched group. Te HR for IBD was 3.91 in celiac patients, which is similar to HRs for Crohn’s disease and ulcerative colitis. 

During follow-up, 644 IBD patients and nearly six-hundred in the matched group were diagnosed with celiac disease. The HR for celiac disease in IBD patients was 5.49, with the highest risk estimates seen in ulcerative colitis, the HR for Crohn’s disease was 3.31.

Even though most patients with celiac disease and IBD are diagnosed in under a year, many experienced HRs of 3-4 even ten years later. 

Over a twenty year follow-up period, 2.5% of celiac patients developed IBD, while 1.3% of IBD patients developed celiac disease.

The team is advising physicians to keep in mind the two-way connection between celiac diagnosis and IBD in the initial assessment and follow-up of both conditions. 

Because of their common co-occurrence, which is independent of the order in which the diseases are contracted, the researchers suggest the potential for a shared etiology between the two conditions.

Read more in the American Journal of Gastroenterology

The researchers are variously affiliated with the Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; the Department of Pediatric Gastroenterology, Queen Silvia Children's Hospital, Gothenburg, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the Celiac Disease Center Department of Medicine Columbia University College of Physicians and Surgeons New York NY USA; the Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; the Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; the Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; the Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; and the Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.

Celiac.com 06/17/2020 - Researchers have found no connection between dietary gluten consumption, and the rates of Crohn’s disease or ulcerative colitis in women without celiac disease, according to data from Digestive Disease Week. The researchers found that for women without celiac disease, "eating gluten does not increase a person's chance of being diagnosed with IBD. We found that dietary gluten intake was not associated with increased risk for ulcerative colitis or Crohn's disease,” says Emily W. Lopes, MD, from Massachusetts General Hospital in Boston.

A team of researchers including Lopez and her colleagues carried out a prospective study of more than 208,000 women without prior diagnosis of celiac disease or IBD at baseline, selected from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study for over a 20 year period. 

The team used semiquantitative food frequency questionnaires given at baseline and every 4 years to calculate the total average dietary intake over the follow-up. They also reviewed patient records to confirm self-reported cases of Crohn’s and UC. 

The team used quintile categories of gluten intake with Cox proportional hazard modeling to calculate multivariable-adjusted hazard ratio and 95% confidence intervals for risk for celiac disease and UC. All models were adjusted for age, BMI, smoking, total caloric intake, dietary pattern, physical activity, appendectomy and medications correlated with risk for IBD.

The team found 272 cases of celiac disease, and 359 cases of ulcerative colitis, over 2,026,573 person-years. Investigators found no link between dietary gluten consumption and patient risk for celiac disease or ulcerative colitis incidence. There was no difference between refined grains and whole grains as the main source of gluten intake, once data was adjusted. Also, neither baseline age, BMI or smoking status changed the findings.

The findings do not cover patients with IBD, since, as Dr. Lopez notes, "...we did not study the impact of gluten intake on those already diagnosed with IBD, thus we cannot expand our results to this population.”

This data was to be presented as part of Digestive Disease Week 2020: Lopes EW, et al. Abstract 847. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).

Read more at Healio.com

Celiac.com 11/28/2012 - A team of researchers recently set out to determine whether childhood antianaerobic antibiotic exposure is associated with the development of inflammatory bowel disease (IBD). Their findings show that children who are treated with antianaerobic antibiotics face a significantly higher risk of developing IBD.

The team included Matthew P. Kronman, MD, MSCE, Theoklis E. Zaoutis, MD, MSCE, Kevin Haynes, PharmD, MSCE, Rui Feng, PhD, and Susan E. Coffin, MD, MPH.They are affiliated variously with the Division of Infectious Diseases, Seattle Children’s Hospital at the University of Washington in Seattle, Washington, the Division of Infectious Diseases at The Children’s Hospital of Philadelphia, and the Department of Biostatistics and Epidemiology, the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania. The team's findings appear in the 24 September issue of Pediatrics.

To get a better picture regarding use of antibiotics on children and a possible connection to IBD, the team conducted a retrospective cohort study using data from 464 UK ambulatory practices in The Health Improvement Network.

The study looked at all children in the network with 2 or more years of follow-up from 1994 to 2009. The team screened and excluded anyone with previous IBD. They then cataloged all antibiotic prescriptions used by all children in the study. Finally, they tracked the children's data from practice enrollment and IBD development, practice de-registration, 19 years of age, or death.

Their defined study parameters included the following antianaerobic antibiotics: penicillin, amoxicillin, ampicillin, penicillin/β-lactamase inhibitor combinations, tetracyclines, clindamycin, metronidazole, cefoxitin, carbapenems, and oral vancomycin.

Their study looked at 1,072,426 children for a total of 6.6 million person-years of follow-up. Of those children, 748 developed IBD. Children treated with antianaerobic antibiotics had nearly 1.52 cases of IBD per ten-thousand person years, while those who were not given antibiotics saw just 0.83 cases per ten-thousand person-years; for an 84% relative risk differential.

Antibiotic exposure throughout childhood was associated with the development of IBD, but this relationship decreased with increasing age at exposure. That is, the longer doctors waited to give children antibiotics, the more the risk of iBD went down.

Children treated with antibiotics before 1 year of age showed an adjusted hazard ratio of 5.51 (95% confidence interval [CI]: 1.66–18.28), while that decreased to 2.62 (95% CI: 1.61–4.25) for children first treated at 5 years old, and to 1.57 (95% CI: 1.35–1.84) for those first treated at 15 years of age. Overall, each course of antibiotics increased the IBD hazard by 6% (4%–8%).

The study showed that children who received two or more antibiotic courses were more highly likely to develop IBD than those who received 1 to 2 courses, with adjusted hazard ratios of 4.77 (95% CI: 2.13–10.68) versus 3.33 (95% CI: 1.69–6.58).

So, based on this study, treating children with antianaerobic antibiotics puts them at risk for developing IBD. It will be interesting to see how the medical community responds to this study, and whether there is greater effort made to avoid giving these powerful antibiotics to children.

What do you think? Do you have IBD? Did you receive these antibiotics as a kid? Let us know your thoughts by commenting below.

Source:

• Pediatrics; 24 September 2012

The research team included J.S. Leeds, B.S. Höroldt, R. Sidhu, A.D. Hopper, K. Robinson, B. Toulson, L. Dixon, A.J. Lobo, M.E. McAlindon, D.P. Hurlstone, and D.S. Sanders. They are affiliated with the Gastroenterology and Liver Unit of Royal Hallamshire Hospital in Sheffield, UK. 

The team recruited patients from clinics specializing in inflammatory bowel disease and celiac disease, along with control subjects from the local population. They then tested subjects for Antigliadins, endomysial, tissue transglutaminase antibodies and total IgA levels. They offered duodenal biopsy to patients with positive antibodies. The team reviewed colonoscopy and biopsy data for celiac patients.

In all, the team assessed 305 patients with celiac disease, 354 patients with IBD, and 601 healthy control subjects. The IBD group included 154 patients with ulcerative colitis (UC), 173 with Crohn's disease, 18 with indeterminate colitis, and nine cases of microscopic colitis. Forty-seven patients showed positive antibodies, while three patients showed villous atrophy upon biopsy.

All three patients with villous atrophy showed positive anti-tissue transglutaminase antibodies, but only two tested positive for endomysial antibody (EMA). Ten celiac patients had IBD (5 UC and 5 lymphocytic colitis). Five control subjects had celiac disease, while two had IBD (1 Crohn's disease and 1 UC). Stepwise multiple logistic regression showed that only antibody positivity was a factor (p<0.0001).

The results showed that people with celiac disease had IBD at rates ten times higher than the control group (odds ratio 9.98, 95% CI 2.8-45.9, p=0.0006), while patients with IBD had celiac disease at about the same rates control subjects (odds ratio 1.02, 95% CI, 0.24-4.29, p=1.0).

Source:

• Open Original Shared Link

The research team included M. Stewart, C. N. Andrews, S. Urbanski, P. L. Beck, and M. Storr. They were looking to better understand how these two diseases might be connected, and to identify any factors that might cause them to occur together.

This led them to conduct a population-based review of all people diagnosed with celiac disease and microscopic colitis in a large Canadian medical center over a 5-year period.

To do that, they searched endoscopy and pathology databases to find all diagnosis made for celiac disease and microscopic colitis within the Calgary Health Region between 2004 and 2008.

To get accurate results, they made sure to standardize age and gender data from their study with 2006 Canadian Census data.

They then used standardized incidence ratios (SIR) to figure out how often the two disease occur together.

In the study population, they found, over a five-year period, 763 patients diagnosed with celiac disease, and 1106 diagnosed with microscopic colitis.

In the general population, the standard rates of celiac disease ran from 10.4 to 15.7 per 100,000 people, while the standard rates of microscopic colitis ran from 16.9 to 26.2 per 100,000 people.

The study team found 40 patients with both celiac disease and microscopic colitis, 21 of whom were females aged 40–60 years.

In the celiac disease group, microscopic colitis occurred at an annual rate of 11.4 per 1000 cases of celiac disease with an overall SIR of 52.7.

These findings showed a strong association between microscopic colitis and celiac disease. In fact, the diseases occurred together in the study population at rates of about 50-times those expected in the general population.

One prominent finding was that middle-aged women suffered especially high rates of celiac disease together with microscopic colitis.

Therefore, the team recommends that middle-aged women with celiac disease and persistent diarrhea undergo lower endoscopy with biopsies to check for microscopic colitis.

Source:

• Open Original Shared Link

An Italian study was designed to research  a gene commonly associated with celiac disease known as MYO IXB, which was recently found to be mutated in IBD patients as well. Additionally, the chromosome 4q27 region is also associated with celiac disease and other autoimmune diseases, and predisposes patients to ulcerative colitis, indicating a common genetic code for these diseases. Although, other IBD risk factors were not found to be candidate genes for celiac disease.

Italian patients with IBD were tested for celiac disease and their results were lower than expected, and  lower than compared with the general population. celiac disease was found to be more prevalent in patients with ulcerative colitis than in those with Crohn's disease. Ulcerative colitis is typically isolated to the colon and is not present in the small intestine. However, there have been reports of diffuse duodenitis in ulcerative colitis patients which is sometimes mistaken for celiac disease.  The gastroduodenal association with Crohn's disease varies from 30% to 80% of patients.

Celiac disease and inflammatory bowel are not related, they are merely two diseases that sometimes cross the same path. While the prevalence of celiac disease in Italian IBD patients was typically low indicating no close relationship between celiac disease and inflammatory bowl disease, the mutual relationship of these diseases lies in the fact that patients with both conditions frequently share a history of iron-deficient anemia.  It is thus important for patients that are unresponsive to treatments for IBD and are prone to incessant anemia, to also test for celiac disease.

Source:

• Open Original Shared Link

The first study assessed the consistency of biomarkers in patients who received multiple Prometheus IBD Serology 7 tests within a two-year period. Overall levels for repeat testing orders were just 2.2%.  Original and repeat tests showed a high degree of agreement. Average variation in biomarker serum concentrations ran between 2.2 EU/mL and 4.3 EU/mL.

Results agreed with prior studies suggesting biomarker stability over similar time periods. Further studies are needed to gauge the impact of therapy on biomarker stability over the long term.

A second, multi-center clinical study of 1,574 subject samples brought the total development cohort of the test to a more heterogeneous 3,626 patient samples.

Results with this large patient cohort further showed that combining multiple markers with Prometheus' Smart Diagnostic Algorithm permits clinicians to better distinguish IBD vs. non-IBD and Crohn's disease vs. ulcerative colitis, compared to standard cutoff value analysis of the individual markers alone.

Prometheus IBD Serology 7 combines multiple serologic markers with a proprietary Smart Diagnostic Algorithm, increasing test sensitivity by more than 25% over single marker sensitivity values.

Source:
Open Original Shared Link

Celiac.com 01/22/2005 - A study by Italian researchers has found that anti-tissue transglutaminase (tTG) antibodies, once considered to be identical to anti-endomysial antibodies (EMA) in celiac disease, can also be found in patients with inflammatory bowel disease. The researchers looked at serum and intestinal tTG levels in 49 patients with Crohns disease, 29 patients with ulcerative colitis, 45 patients with celiac disease, 85 autoimmune patients as disease controls, and 58 volunteers as healthy controls. Additionally, Immunoglobulin A (IgA) anti-recombinant human tissue transglutaminase and anti-endomysial antibody detection in sera and fecal supernatants, along with adsorption of positive sera with recombinant human tissue transglutaminase, were performed on all patients.

The researchers detected an increase in tTG concentration in all patients with celiac disease, and also low positive values in those with Crohns disease and ulcerative colitis, however the EMA were only detected in those with celiac disease. According to the researchers, the "Data highlight that both circulating and intestinal anti-tissue transglutaminases are detectable in inflammatory bowel disease, and that they are related to disease activity. These features underline that, in addition to anti-tissue transglutaminase, an anti-endomysial antibody test is necessary in the diagnostic work-up of celiac sprue, especially in patients with known inflammatory bowel disease."

This study supports Open Original Shared Link that have found that the sole use of tTG to diagnose celiac disease may lead to misdiagnoses, and EMA testing must be performed to make an accurate celiac disease diagnosis.

Am J Gastroenterol 2000;95:2154-2156,2285-2295.

Celiac.com 10/14/2000 - According to new research done by Dr. Andrew J. Wakefield, of the Royal Free and University College Medical School, in London (published in the September issue of the American Journal of Gastroenterology) children with developmental disorders seem to be at risk of developing a unique type of inflammatory bowel disease (IBD). This newly discovered type lacks the typical features seen in Crohns disease and ulcerative colitis.

The researchers studied 60 children with developmental disorders (50 had autism, five had Aspergers syndrome, two had disintegrative disorder, one had attention deficit hyperactivity disorder, one had schizophrenia and one had dyslexia.) whose ages ranged from 3 to 16 years old to compare the clinical and histologic features against 37 developmentally normal controls who underwent evaluation for possible IBD.

According to Dr. Wakefield and colleagues The combination of ileocolonic lymphoid nodular hyperplasia and colitis in children with developmental disorders distinguished them from developmentally normal children with similar symptoms (including abdominal pain and constipation) in whom lymphoid nodular hyperplasia and histopathological change were uncommon. They emphasize that their finding are consistent with those of other recent case studies, and that in their study inflammatory changes were detected in the upper gastrointestinal tract that were unique in children with autism and IBD, compared with developmentally normal children with IBD.

Further, there is accumulating evidence of a specific type of enterocolitis in autism that makes it tempting to suggest that a gut-brain interaction is involved in the pathogenesis of what many researchers are now calling autistic enterocolitis. The detection of opioid peptides of dietary origin in the urine of some of the affected children further supports this theory. The team emphasizes that further studies and more evidence is needed to establish a direct link between an inflamed gut and the brain in those with autism.