Does autistic enterocolitis exist?

In the linked feature (doi: 10.1136/bmj.c1127),1 Brian Deer tries to unravel the journey of the histopathological reports on the biopsies that formed the basis of the recently retracted study by Andrew Wakefield and colleagues in the Lancet,2 which introduced the entity “autistic enterocolitis.” Apparently, the biopsies were first reported on by Susan Davies, a consultant histopathologist and coauthor on the study, but they were also seen and interpreted by three other coauthors before final publication. One of them was Professor Amar Dhillon, also a consultant histopathologist, although his role was apparently only to grade the biopsy inflammation on a grading sheet.1 However, there has been some dispute about this grading sheet, or proforma. In a letter published in 2007,3 Wakefield stated that it was designed by Dhillon and published by Wakefield’s group in 2000,4 although Dhillon was not a coauthor of the latter paper. This proforma published in 2000 referred to some unusual histopathological changes, such as “disruption of the epithelial basal lamina” and “condensation of the lamina propria”—terms with which few gastrointestinal pathologists would be familiar—and also referred to hyperplasia of mucosal lymphoid follicles, the importance of which is disputed.5 However, in a response to Wakefield’s 2007 letter, Dhillon denied that he had designed the proforma, stating that he provided one that he did design, which was based on British Society of Gastroenterology guidelines, and from which most of these terms are missing.6

The biopsy sections were also examined by Andrew Anthony, then a junior pathologist, and by Wakefield, who as Deer points out is not a professional pathologist but a surgeon. It might be assumed that such a plethora of opinions would have produced consensus about the nature of the histopathological changes. …