Disaccharidase activity in children with inflammatory bowel disease

Abstract

Background/Aims: The etiopathogenesis of inflammatory bowel disease (IBD) is multifactorial and not well explained. Environmental, genetic, and dietary factors play an important role. The aim of the study was the evaluation of lactase, saccharase, and maltase activity in patients with IBD. Materials and Methods: The study comprised 65 children, aged 3-18 years. During a routine endoscopy, we took biopsies from the descending part of the duodenum. In these biopsies, we determined disaccharidase activity using Dahlquist's method. Results: Decreased lactase activity in the biopsies taken from the small intestine mucosa was most frequently observed in patients with Crohn's disease (5/15-33%) and least frequently seen in children with lymphocytic colitis (in 1/10-10%). The lowest mean values of lactase activity were found in the children with Crohn's disease and ulcerative colitis (1.7-2.5 U/1 g). Decreased saccharase activity in the biopsies obtained from the small intestine mucosa was most frequently observed in patients with lymphocytic colitis (in 5/10-50%) and ulcerative colitis (9/20-45%) and least frequently seen in children with non-specific undetermined colitis (in 7/20-35%). Decreased maltase activity in the small bowel mucosa was the most frequently observed in patients with Crohn's disease (in 5/15-33%) and least frequently seen in children with ulcerative colitis (in 3/20-15%). The lowest mean values of maltase activity were found in the children with Crohn's disease (5.4 U/1 g). Conclusion: Therefore, it seems reasonable to perform diagnostic examinations aimed at lactose, saccharose, and maltose intolerance and to initiate a dietary regimen in children with IBD.

Retrospective study recommends endoscopy when diagnosing lymphocytic colitis or eosinophilic gastrointestinal disorder in children with abdominal pain

“…The difference in prevalence of insufficient lactase production in the patients with and without LC and EGID could indicate that there was an association between these two conditions and insufficient lactase production, as found in other studies . Thus, it seems important to screen for lactase deficiency in LC and EGID, as some cases may be linked to lactase deficiency, primary or acquired, and may be treated effectively by a lactose‐free diet .…”

“…Of the 58 patients who underwent endoscopy and did not have LC or EGID, 29 had enzyme activity tests and these revealed seven (24.1%) cases of lactase deficiency. Genetically determined adult‐type hypolactasia was excluded in all but one case and thus lactase deficiency seemed secondary to small bowel pathology .…”

“…It is unknown if lactase deficiency is transitional or secondary to some other unidentified aetiology of LC or EGID, but generally, besides LC and EGID, gastrointestinal endoscopy in patients with RAP can reveal insufficient lactase production and the RAP can be eliminated with a lactose‐free diet .…”

Association of lymphocytic colitis and lactase deficiency in pediatric population

“…We have some important findings to report, among which and the most important, is that for the first time, a possible link between lactase deficiency and lymphocytic colitis has been identified, and the implications derived from this observation cannot be understated. Of note, a recent report by Wiecek et al seems to support this observation [25], which came to our attention since the article was first drafted.…”

The relationship between disaccharidase deficiencies and irritable bowel syndrome in childre - A literature review

“…Strikingly, a 2012 study by Treem also found constipation to be a common presenting complaint, although the pathophysiology of this presentation was not explained 12 . While disaccharidase deficiencies have been implicated in many other gastrointestinal disorders [21][22][23][24] , their existence in patients with IBS-like symptoms remains unclear. Moreover, some patients with disaccharidase deficiencies did not have resolution of these IBS-like symptoms despite appropriate treatment for their deficiency 5 .…”