Disaccharidase Deficiencies in Children With Chronic Abdominal Pain

• Published in: JPEN. Journal of parenteral and enteral nutrition 2017-03, Vol.41 (3), p.463-469
• Main Authors: El-Chammas, Khalil, Williams, Sara E., Miranda, Adrian
• Format: Article
• Language: English
• Subjects: Abdominal Pain - blood; Abdominal Pain - etiology; Adolescent; carbohydrate malabsorption; Carbohydrate Metabolism, Inborn Errors - blood; Carbohydrate Metabolism, Inborn Errors - complications; Child; chronic abdominal pain; Chronic Disease; disaccharidases; Disaccharidases - administration & dosage; Disaccharidases - blood; Disaccharidases - deficiency; Disaccharidases - metabolism; Female; functional gastrointestinal disorders; Glucan 1,4-alpha-Glucosidase - metabolism; Humans; Lactase - metabolism; Malabsorption Syndromes - blood; Malabsorption Syndromes - complications; Male; Prospective Studies; Retrospective Studies; Sucrase - metabolism; Wisconsin
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607115594675

Objectives: Carbohydrate intolerance or malabsorption has been suggested as a cause of chronic abdominal pain (CAP) in a subset of patients. We aimed to evaluate disaccharidase deficiencies in children with functional CAP and to correlate deficiencies with clinical features. Method: Patients presenting to the gastroenterology clinic at Children’s Hospital of Wisconsin with abdominal pain prospectively completed a detailed demographic, history, and symptom questionnaire. The CAP cohort included those with at least 1 month of symptoms. Data on disaccharidase activity and histology of endoscopic biopsies were collected retrospectively. Only patients with normal histology were included in the study. The association between groups with low disaccharidases and clinical features was examined. Results: A total of 203 pediatric patients with CAP were included. The mean (SD) age was 11.5 (3.1) years, and 32.5% were male. The percentages of abnormally low disaccharidase levels using the standard laboratory cutoffs were lactase, 37%; sucrase, 21%; glucoamylase, 25%; and palatinase, 8%. Thirty-nine percent of the patients with low lactase also had low sucrase, and 67% of the patients with low sucrase had low lactase. There was no significant difference in the activities of any of the disaccharidases or sucrase/lactase ratio in relation to age. Also, no association was found between stool consistency, stool frequency, or location of pain and low disaccharidase activity. Conclusions: A large proportion of patients with CAP have deficiencies in disaccharidases. Bowel frequency, vomiting, or location of pain was no different between groups, suggesting that these clinical features cannot be used to predict disaccharidase deficiencies.