Disaccharidase Deficiencies in Children with Abdominal Pain
Alan Gaby, M.D.
Author: El-Chammas K, et al
Reference: Disaccharidase deficiencies in children with chronic abdominal pain. JPEN J Parenter Enteral Nutr 2017;41:463-469.
Design: Biochemical assessment of small-intestinal biopsy samples.
Participants: Two hundred three children (mean age, 11.5 years) with chronic abdominal pain who presented to the gastroenterology clinic at Children’s Hospital of Wisconsin
Study Medication and Dosage: None
Primary Outcome Measure: The activity of disaccharidase enzymes in the biopsy samples.
Key Findings: The proportion of children with abnormally low disaccharidase activity was 37% for lactase, 21% for sucrase, 25% for glucoamylase (which cleaves glucose from maltose or starch), and 8% for palatinase (sucrase-isomaltase). Thirty-nine percent of the children with low lactase also had low sucrase, and 67% of those with low sucrase also had low lactase.
Practice Implications: Lactose, sucrose, maltose, and isomaltose are the major disaccharides present in the human diet. These non-absorbable disaccharides are hydrolyzed to absorbable monosaccharides by disaccharidase enzymes present in the small-intestinal mucosa. It is well known that malabsorbed lactose is fermented by intestinal bacteria, which leads to the production of gases that can cause various gastrointestinal symptoms. Individuals with lactase deficiency often experience an improvement in various gastrointestinal symptoms when they avoid cow’s milk and other lactose-containing foods. Similarly, people with congenital sucrase deficiency experience an improvement in gastrointestinal symptoms when they avoid sucrose-containing foods.
In the present study, disaccharidase deficiencies were found to be common in children with chronic abdominal pain. In lieu of a small-bowel biopsy, a therapeutic trial of restricting dietary intake of lactose, sucrose, maltose, and isomaltose may relieve symptoms in some cases. After clinical improvement occurs, gradual reintroduction of disaccharides might help the patient determine which disaccharides they can tolerate and at what level of intake. Information on how to consume a low-disaccharide diet is available on the Internet.[i]
[i] Breaking the Vicious Cycle. http://www.breakingtheviciouscycle.info/legal/listing. Accessed August 17, 2017.