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Zhou K, Peng M, Tan Z, Xiao N. Diarrhea Caused by High-Fat and High-Protein Diet Was Associated With Intestinal Lactase-Producing Bacteria. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:691-699. [PMID: 37051624 PMCID: PMC10441099 DOI: 10.5152/tjg.2023.22451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/09/2022] [Indexed: 04/14/2023]
Abstract
BACKGROUND/AIMS This study aimed to investigate the effect of diarrhea induced by a high-fat and high-protein diet on lactase-producing bacteria in the intestinal contents of mice from the perspective of diarrhea-related genes. MATERIALS AND METHODS Ten specific pathogen-free Kunming male mice were chosen and randomly divided into the normal group and model group. The mice in the normal group were fed with high-fat and high-protein diet plus gavage of vegetable oil, while those in the model group were fed with general diet plus gavage of distilled water. After successful modeling, the distribution and diversity of lactase-producing bacteria in the intestinal contents were characterized by metagenomic sequencing technology. RESULTS After high-fat and high-protein diet intervention, Chao1, observed species index, and operational taxonomic units number decreased in the model group (P > .05), while the Shannon, Simpson, Pielou's evenness, and Goods coverage indices increased (P > .05). The principal coordinate analysis showed that the composition of lactase-producing bacteria differed between the normal group and model group (P < .05). The lactase-producing bacterial source in the intestinal contents of mice was Actinobacteria, Firmicutes, and Proteobacteria, of which Actinobacteria was the most abundant phylum. At the genus level, both groups had their unique genera, respectively. Compared to the normal group, the abundance of Bifidobacterium, Rhizobium, and Sphingobium increased, while Lachnoclostridium, Lactobacillus, Saccharopolyspora, and Sinorhizobium decreased in the model group. CONCLUSION High-fat and high-protein diet altered the structure of lactase-producing bacteria in the intestinal contents, elevating the abundance of dominant lactase-producing bacteria, while decreasing the richness of lactase-producing bacteria, which may further induce the occurrence of diarrhea.
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Affiliation(s)
- Kang Zhou
- Hunan University of Chinese Medicine Faculty of Pharmacy, Changsha, Hunan, China
| | - Maijiao Peng
- Hunan University of Chinese Medicine Faculty of Pharmacy, Changsha, Hunan, China
| | - Zhoujin Tan
- Hunan University of Chinese Medicine Faculty of Medicine, Changsha, China
| | - Nenqun Xiao
- Hunan University of Chinese Medicine Faculty of Pharmacy, Changsha, Hunan, China
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Zhou K, Peng M, Deng N, Tan Z, Xiao N. Lactase bacteria in intestinal mucosa are associated with diarrhea caused by high-fat and high-protein diet. BMC Microbiol 2022; 22:226. [PMID: 36171559 PMCID: PMC9516839 DOI: 10.1186/s12866-022-02647-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Excessive fat and protein in food can cause diarrhea by disturbing the intestinal microecology. Lactase is a functional enzyme strongly associated with diarrhea, while lactase bacteria in the intestine are an important source of microbial lactase. Therefore, we reconnoiter the relationship between diarrhea induced by a high-fat and high-protein diet (HFHPD) and intestinal mucosal lactase bacteria from the perspective of functional genes. Result Operational Taxonomic Units (OTUs) were 23 and 31 in the normal group (NM) and model group (MD), respectively, and 11 of these were identical. The Chao1 and Observed specie indexes in the MD were higher than those in the NM, but this was not significant (P > 0.05). Meanwhile, the Principal coordinate analysis (PCoA) and Adonis test showed that the community structures of lactase bacteria in NM and MD were significantly different (P < 0.05). In taxonomic composition, lactase bacteria on the intestinal mucosa were sourced from Actinobacteria and Proteobacteria. Where Actinobacteria were higher in NM, and Proteobacteria were higher in MD. At the genus level, Bifidobacterium was the dominant genus (over 90% of the total). Compared to NM, the abundance of Bifidobacterium were lower in MD, while MD added sources for lactase bacteria of Rhizobium, Amycolatopsis, and Cedecea. Conclusions Our data demonstrate that HFHPD altered the community structure of lactase bacteria in the intestinal mucosa, decreased the abundance of the critical lactase bacteria, and promoted the occurrence of diarrhea.
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Affiliation(s)
- Kang Zhou
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Maijiao Peng
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Na Deng
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhoujin Tan
- Hunan Key Laboratory of TCM Prescription and Syndromes Translational Medicine, Changsha, Hunan, China.,College of Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Nenqun Xiao
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, Hunan, China.
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3
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Pediatric Aspects of Nutrition Interventions for Disorders of Gut-Brain Interaction. Am J Gastroenterol 2022; 117:995-1009. [PMID: 35416794 PMCID: PMC9169765 DOI: 10.14309/ajg.0000000000001779] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/09/2022] [Indexed: 12/11/2022]
Abstract
Dietary factors may play an important role in the generation of symptoms in children with disorders of gut-brain interaction (DGBIs). Although dietary modification may provide successful treatment, there is a relative paucity of controlled trials that have shown the effectiveness of dietary interventions. This study is a narrative review that explores the existing literature on food and pediatric DGBIs. The following have been shown to be beneficial: (i) in infants with colic, removing cow's milk from the infant's diet or from the maternal diet in those who are breastfed; (ii) in infants with regurgitation, adding thickeners to the formula or removing cow's milk protein from the infant's diet or the maternal diet in those who are breastfed; and (iii) in children with pain-predominant DGBIs, using soluble fiber supplementation or a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. In children with functional constipation, there is no evidence that adding fiber is beneficial. Given that most dietary interventions include restriction of different foods in children, a thoughtful approach and close follow-up are needed.
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Marciano ND, Chehter EZ. THE ROLE OF ENDOSCOPY IN DYSPEPTIC SYNDROME IN CHILDREN AND ADOLESCENTES. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:257-262. [PMID: 35830038 DOI: 10.1590/s0004-2803.202202000-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dyspepsia is pain or discomfort in the epigastric region, and can be subdivided into organic and functional. The diagnosis of functional dyspepsia is based on the criteria defined by the Rome committee. In the pediatric population, functional dyspepsia is more common than organic dyspepsia, in addition to being part of a set of diseases called defined gastrointestinal disorders, defined by the Rome IV criteria. The most efficient diagnostic method of functional dyspepsia in the pediatric population is still uncertain since endoscopy is an important test to rule out organic changes, but it is invasive to be performed on a large scale. OBJECTIVE To evaluate the role of endoscopy in the diagnosis of functional dyspepsia in pediatric patients, aiming at preventing invasive procedures and reaching high specificity in the result, which is important to determine the best diagnostic guideline for these patients. METHODS Narrative literature review study performed by searching for articles in the PubMed/Medline and LILACS database using the PRISMA method. RESULTS A total of 102 articles were found in PubMed, 15 of which were selected for the study. In the LILACS database, nine articles were found and one was selected. Thus, 16 articles were selected for the study. The most appropriate indications for endoscopy, how to differentiate organic from functional dyspepsia without endoscopy, the main endoscopic findings of the studies, the differences between Rome III and Rome IV criteria, and the prevalence and factors possibly associated with functional dyspepsia were approached through the selected articles. CONCLUSION The main indication for endoscopy is the presence of alarm symptoms in pediatric patients with dyspepsia and the Rome clinical criteria are efficient for the diagnosis of functional dyspepsia. However, there is still no standardized diagnostic guideline to be followed in this age group.
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Zhou K, Xiao NQ, Tan ZJ. Intestinal microecological mechanism for Baohe Pill to treat food-stagnation-type gastrointestinal diarrhea. Shijie Huaren Xiaohua Zazhi 2022; 30:217-222. [DOI: 10.11569/wcjd.v30.i5.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Food-stagnation-type gastrointestinal diarrhea is a common disease caused by improper diet and overeating in children, and Baohe Pill is a traditional effective way to treat the disease. With the development of the concept of intestinal microecology and metagenomics in recent years, it has been found that the mechanism of Baohe Pill in the treatment of food-stagnation-type gastrointestinal diarrhea is associated with intestinal microecology. This paper will discuss the progress in the research of intestinal microecology of Baohe Pill in the treatment of diarrhea due to food stagnation in the gastrointestinal tract, with an aim to provide a reference for the research on the pharmacodynamic mechanism of Baohe Pill.
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Effect of Whole-Course Continuous Nursing Intervention Combined with a Nursing Practice Teaching Method on Quality of Life of Children with Functional Dyspepsia and Parents’ Satisfaction Based on Smart Health. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8638564. [PMID: 35222895 PMCID: PMC8866003 DOI: 10.1155/2022/8638564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022]
Abstract
With the development of information technology, it has become a part of people’s lives. WeChat is not only a popular chatting tool in daily life but can also be used in the medical field. Functional dyspepsia is a common pediatric disease, with complex pathogenic factors, which are usually attributed to abnormal gastric acid secretion and gastrointestinal dysfunction. In our research, we aim to investigate the effects of whole-course continuous nursing intervention combined with a nursing practice teaching method on the quality of life (QOL) of children with functional dyspepsia and parents’ satisfaction. One hundred and twenty children with functional dyspepsia admitted to our hospital (February 2019–February 2020) were retrospectively analyzed and equally divided into the experimental group (EG) and the control group (CG) according to the order of admission. The CG received whole-course continuous nursing intervention, and the EG received whole-course continuous nursing intervention combined with the nursing practice teaching method. Children’s psychological states and QOL and parents’ satisfaction of both groups were compared. After discharge, compared with the CG, the negative emotion scores in the EG were remarkably lower (
). After discharge, compared with the CG, the QOL scores (
), the proportion of children with good and excellent QOL (
), and parents’ satisfaction (
) in the EG were remarkably higher. For children with functional dyspepsia, whole-course continuous nursing intervention combined with the nursing practice teaching method can improve their negative emotions, QOL, and parents’ satisfaction, which should be popularized in practice.
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Disaccharidase Deficiency in Pediatric Patients with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Disaccharidase (DS) deficiencies have been reported in pediatric patients with inflammatory bowel disease (IBD), but the relationship between duodenal inflammation and DS deficiency has not been evaluated outside of lactase deficiency. Methods: This study assessed DS levels and DS deficiencies in pediatric IBD patients who underwent endoscopy with assessment of DS activity. Records were reviewed for IBD subtype, pathology findings, and the results of DS analysis. Results: A total of 136 patients were identified. Overall, 89 (65.4%) patients had a diagnosis of Crohn’s disease (CD), 31 (22.8%) patients had a diagnosis of ulcerative colitis (UC), and 16 (11.8%) patients had a diagnosis of indeterminant colitis. Lactase deficiency was identified in 55.9% of patients, followed by maltase deficiency (19.9%), sucrase and palatinase deficiency (14%), and pan-deficiency (12.5%). When analyzing only patients with CD, patients with duodenitis were more likely to exhibit sucrase deficiency, palatinase deficiency, and pan-deficiency with a trend towards maltase deficiency. Conclusions: The most common DS deficiency was lactase deficiency; however, this was not related to duodenal inflammation. Pediatric patients with CD and duodenal inflammation exhibit DS deficiencies, namely, sucrase, palatinase, and pan-deficiency. Dietary adjustments may be warranted temporarily until duodenal inflammation is healed in patients with CD and duodenitis.
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8
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A comprehensive review of functional dyspepsia in pediatrics. Clin J Gastroenterol 2021; 15:30-40. [PMID: 34854065 DOI: 10.1007/s12328-021-01561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Functional gastrointestinal disorders have been known as a diagnosis of exclusion since the Rome Foundation first created these criteria in 1990. Since that time, a large amount of research and clinical data has better clarified the mechanisms and treatment options for these. Functional dyspepsia is caused by physiologic, genetic, environmental, and psychological factors, as well as various functional abnormalities, such as increased sensitivity to acid, increased sensitivity to duodenal lipids and low-grade inflammation. This disorder has significant symptom overlap between other functional disorders, such as irritable bowel syndrome and gastroparesis, but has differential criteria and two new subclasses: postprandial distress syndrome and epigastric pain syndrome. Diagnosis of functional dyspepsia should be based upon appropriate clinical evaluation in tandem with Rome IV criteria. In recent years, many treatment measures for functional dyspepsia have been studied, such as pharmacologic intervention, behavioral therapy, or alternative therapy, an example being hypnotherapy. These treatment measures have proven to be effective in symptom reduction in pediatrics. Though this disorder is functional, it has been shown to cause a significant impact on pediatric patients' quality of life continuing into adulthood.
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Friesen C, Colombo JM, Deacy A, Schurman JV. An Update on the Assessment and Management of Pediatric Abdominal Pain. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:373-393. [PMID: 34393542 PMCID: PMC8354769 DOI: 10.2147/phmt.s287719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Chronic abdominal pain is very common in children and adolescent and results in high personal and social costs. Most youth with chronic abdominal pain fulfill criteria for a functional abdominal pain disorder (FAPD) as defined by Rome criteria. These are complex conditions with a wide array of biological, psychological, and social factors contributing to the experience of pain. The purpose of the current review is to provide an overview of the pathophysiology of FAPDs and an up-to-date summary of the literature related to FAPDs in children and adolescents, with additional focus on several areas (eg, diet and probiotics) where patients and families frequently have questions or implement self-directed care. We also provide an approach to the assessment and treatment of pediatric FAPDs focusing on the robust literature regarding psychological interventions and much sparser literature regarding medication treatment.
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Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Deacy
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
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Colombo JM, Friesen CS, Garg U, Friesen CA, Pablo WS. Relationships between disaccharidase deficiencies, duodenal inflammation and symptom profile in children with abdominal pain. Sci Rep 2021; 11:4902. [PMID: 33649365 PMCID: PMC7921103 DOI: 10.1038/s41598-021-84535-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and without histologic duodenitis. Lastly, relationships between individual gastrointestinal symptoms or symptom complexes were evaluated. Lactase deficiency was found in 34.3% of patients and disaccharidase pan-deficiency in 7.6%. No individual symptoms or symptom complexes predicted disaccharidase deficiency. While duodenitis was not associated with disaccharidase deficiency, it was only present in 5.9% of patients. Disaccharidase deficiency, particularly lactase deficiency, is common in youth with abdominal pain and multiple deficiencies are not uncommon. Disaccharidase deficiency cannot be predicted by symptoms in this population. Further studies are needed to assess the clinical significance of disaccharidase deficiency.
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Affiliation(s)
- Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64109, USA
| | - Chance S Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64109, USA
| | - Uttam Garg
- Pathology and Laboratory Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Craig A Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64109, USA.
| | - William San Pablo
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64109, USA
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Deb C, Campion S, Derrick V, Ruiz V, Abomoelak B, Avdella A, Zou B, Horvath K, Mehta DI. Sucrase-isomaltase Gene Variants in Patients With Abnormal Sucrase Activity and Functional Gastrointestinal Disorders. J Pediatr Gastroenterol Nutr 2021; 72:29-35. [PMID: 32732636 DOI: 10.1097/mpg.0000000000002852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of the study was to determine prevalence and characterize sucrase-isomaltase (SI) gene variants of congenital sucrase-isomaltase deficiency in non-Hispanic white pediatric and young adult patients with functional gastrointestinal disorders (FGIDs), and abnormal sucrase activity on histologically normal duodenal biopsy. METHODS Clinical symptoms and disaccharidase activities data were collected for an abnormal (low) sucrase (≤25.8 U, n = 125) activity group, and 2 normal sucrase activity groups with moderate (≥25.8-≤55 U, n = 250) and high (>55 U, n = 250) sucrase activities. SI gene variants were detected by next-generation sequencing of DNA from formalin-fixed paraffin-embedded tissues of these patients. FGIDs symptoms based on Rome IV criteria and subsequent clinical management of abnormal sucrase activity cases with pathogenic SI gene variants were analyzed. RESULTS Thirteen SI gene variants were found to be significantly higher in abnormal sucrase cases with FGIDs symptoms (36/125, 29%; 71% did not have a pathogenic variant) compared to moderate normal (16/250, 6.4%, P < 0.001) or high normal (5/250, 2.0%, P < 0.001) sucrase groups. Clinical management data were available in 26 of abnormal sucrase cases, and only 10 (38%) were correctly diagnosed and managed by the clinicians. Concomitant lactase deficiency (24%; 23/97) and pan-disaccharidase deficiency (25%; 13/51) were found in the abnormal sucrase group. CONCLUSIONS Heterozygous and compound heterozygous mutations in the SI gene were more prevalent in cases with abnormal sucrase activity presenting with FGIDs, and normal histopathology. This suggests heterozygous pathogenic variants of congenital sucrase-isomaltase deficiency may present as FGIDs. Concomitant lactase or pan-disaccharidase deficiencies were common in abnormal sucrase cases with SI gene variants.
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Affiliation(s)
- Chirajyoti Deb
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Stephani Campion
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Veronica Derrick
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Vanessa Ruiz
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Bassam Abomoelak
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Angelina Avdella
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
| | - Baiming Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Karoly Horvath
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
- Pediatric center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL
| | - Devendra I Mehta
- Gastroenterology Translational Research Division, Arnold Palmer Hospital Specialty Diagnostic Laboratory
- Pediatric center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL
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Wasuwanich P, Choudry H, Ingviya T, Scheimann AO, AuYeung KJ, Karwowski C, Billet S, Nichols BL, Karnsakul W. A retrospective study on the association of gastrointestinal symptoms in children with low lactase activity and low activity of other disaccharidases. BMC Gastroenterol 2020; 20:331. [PMID: 33036568 PMCID: PMC7545868 DOI: 10.1186/s12876-020-01443-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disaccharides such as lactose and sucrose are sugars commonly found in human diet. They are broken down by mucosal disaccharidases in the duodenum. Previous small studies found no associations between gastrointestinal (GI) symptoms and combined low disaccharidase activity. We aim to explore the associations of low activity of disaccharidase and combinations of low activity of different disaccharidases with general GI symptom presentations in a large cohort of pediatric patients. METHODS We examined a cohort (0-21 yrs.) who have undergone esophagogastroduodenoscopy and received disaccharidase activity assay from duodenal biopsy in the time period 2010 to 2012. Disaccharidase assays tested for activity of lactase, sucrase, maltase, and palatinase. GI symptoms were grouped into four categories, abdominal pain, diarrhea, weight loss, and gastroesophageal reflux. RESULTS Of the 347 subjects, we found an association between low lactase activity and abdominal pain (OR = 1.78; 95% CI = 1.07-2.97; p < 0.05). Subjects with a lactase/sucrase ratio < 0.2 were found to be associated with abdominal pain (OR = 2.25; 95% CI = 1.25-4.04; p < 0.05), Subjects with low pandisaccharidase may be correlated with abdominal pain and have a unique frequency of GI symptoms due to low frequency of diarrhea and weight loss, but they were not statistically significant. CONCLUSIONS Low activities of certain disaccharidase combinations may be associated with GI symptoms in subjects; a prospective study may be needed to investigate further.
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Affiliation(s)
- Paul Wasuwanich
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Hassan Choudry
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Thammasin Ingviya
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Ann O Scheimann
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Karla J AuYeung
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Division of Gastroenterology, Valley Children's Healthcare, Madera, CA, USA
| | - Christine Karwowski
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Susan Billet
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Buford L Nichols
- USDA Children's Nutrition Research Center, Baylor College of Medicine, and Texas Children's Hospital, Houston, TX, USA
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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Abstract
PURPOSE OF REVIEW Disaccharidase testing, as applied to the evaluation of gastrointestinal disturbances is available but it is not routinely considered in the diagnostic work-up. The purpose of this review was to determine if disaccharidase testing is clinically useful and to consider how the results could alter patient management. RECENT FINDINGS Indicate that carbohydrate maldigestion could contribute functional bowel disorders and negatively impact the fecal microbiome. Diagnostic techniques include enzyme activity assays performed on random endoscopically obtained small intestinal biopsies, immunohistochemistry, stable isotope tracer and nonenriched substrate load breath testing, and genetic testing for mutations. More than 40 sucrase--isomaltase gene variants coding for defective or reduced enzymatic activity have been reported and deficiency conditions are more common than previously thought. SUMMARY The rationale for disaccharidase activity testing relates to a need to fully assess unexplained recurrent abdominal discomfort and associated symptoms. All disaccharidases share the same basic mechanism of mucosal expression and deficiency has far reaching consequences. Testing for disaccharidase expression appears to have an important role in symptom evaluation, but there are accuracy and logistical issues that should be considered. It is likely that specific recommendations for patient management, dietary modification, and enzyme supplementation would come from better testing methods.
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Affiliation(s)
- Antone R. Opekun
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Section of Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Houston, TX, USA
| | - Bruno P. Chumpitazi
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Section of Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Houston, TX, USA
| | - Mustafa M. Abdulsada
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Buford L Nichols
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Director Emeritus, USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
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14
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Puertolas MV, Fifi AC. The Role of Disaccharidase Deficiencies in Functional Abdominal Pain Disorders-A Narrative Review. Nutrients 2018; 10:E1835. [PMID: 30501067 PMCID: PMC6315563 DOI: 10.3390/nu10121835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022] Open
Abstract
Disaccharidase deficiencies are reportedly underdiagnosed in pediatric populations. Though typically thought to cause diarrheal disease, they can also be a cause of abdominal pain and dyspepsia, and patients diagnosed with these functional disorders may actually have associated enzyme deficiencies. While the effects of lactose deficiency have been widely studied, sucrase, maltase, and isomaltase are less frequently considered when approaching a patient with an apparent functional abdominal pain disorder. This review seeks to provide an up-to-date narrative on the current scientific literature on the possible role of sucrase, maltase, and isomaltase deficiency in pediatric functional gastrointestinal disorders.
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Affiliation(s)
- Mora V Puertolas
- Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine/Jackson Memorial Medical Center, 1611 NW 12th Ave, Miami, FL 33136, USA.
| | - Amanda C Fifi
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL 33137, USA.
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Complementary Starch Feeding of the Young Child: Starch Digestion Consortium Workshop 18. J Pediatr Gastroenterol Nutr 2018; 66 Suppl 3:S1-S3. [PMID: 29762366 DOI: 10.1097/mpg.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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