الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Pervasive developmental disorders are behavioral disorders with onset before 36 months characterized by impairment of social interest and behaviors. Other characteristics include, sensory dysfunction, in appropriate laughing , giggling little or no eye contact, apparent insensitivity to pain, preference to be alone and many more according to the American psychiatric associations.
In the last 20 years, there has been an increase in the incidence of pervasive developmental disorders, unexplained by genetic alone, nor can this increase be secondary to only increased awareness. The etiology of PDDs is complex and usually, the underlying pathologic mechanisms are unknown.
It has suggested that peptides formed through the incomplete breakdown of foods containing gluten and casein derived from dairy product. Individuals who cannot metabolize gluten produce antigliadin which they can not metabolized further. Gastrointestinal diseases are more common in children
with neurological disability and previous reports describe unexpected intestinal inflammation with low grade colitis.
Instead of completely digesting and excreting these opioid proteins, some of the partially digested gluten and casein proteins leak out of the gut and are transported to other parts of the body before they can be completely digested .The opoid protein travel through the blood stream cross the blood brain barrier (The barrier between the brain and the rest of the body), enter brain and stimulate morphine like effect casein protein negatively affect the brain by causing inattentiveness, unclear thinking and irregular sleeping and eating patterns .
Researchers reported that children have shown mild to dramatic improvement in speech and/or behavior after gluten was removed from their diet. Some also reported that their children have experienced fewer bouts of diarrhea after starting gluten free diet .
Dipeptidyl peptidase IV (DPP-IV) is the only known enzyme to breakdown osmorphine. Dipeptidyl peptidase IV (DDP-IV) appears to be absent or reduced in pervasive developmental disorders. The gene for this enzyme is distal to other suspected pervasive developmental disorders genes and is expressed in the kidney small intestine, liver and the blood brain barriers and has involvement in T-cell activation .The toxicity of gluten and casein may result from the lack of DPP4 .
The aim of the study is to detect prevalence of gastrointestinal disturbances in pervasive developmental disorders to study determinants of gastrointestinal disturbances and variables of pervasive developmental disorders the present study included 2 groups of children, the patient contain 45 pervasive developmental disorders all of them autistic disorders children (36 male and 9 female), their age was ranging between 3-12 years the control group contains 45 apparently healthy children 36 male and 9 females. Their age was ranging between 3-12 years. The ratio between boys and girls intake PDDs (autistic disorders) was 3.5: 1 and this was in accordance with all studies of PDDs, which have shown a predominance of boys over girls. Ratio of 3 or 4 boys to 1 girl have consistently been reported .
Our studied patients with PDDs showed statically higher serum levels of IgM class antibodies to gliadin and serum casein antibodies compared healthy controls.
In our present study, serum levels of DPP-IV were significantly lower compared to healthy control. The number of Dpp4 deficient cases is 21 of total 45cases and represents 46.7% of total.
The main gastrointestinal symptoms of the patients suffering from PDDs were abdominal distension in 20 patients, constipation in 16 patients (35.6%) , vomiting in 9 patients (20%), food sensitivity in 19 patients (42.2%) and recurrent attacks of crampy pains in the abdomen in14 patients (31.1).