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Title: Demographic and clinical correlates of mucosal disaccharidase deficiencies in children with functional dyspepsia

Author
item CHUMPITAZI, BRUNO - Baylor College Of Medicine
item ROBAYO-TORRES, CLAUDIA - Children'S Nutrition Research Center (CNRC)
item TSAI, CYNTHIA - Baylor College Of Medicine
item OPEKUN, ANTONE - Baylor College Of Medicine
item BAKER, SUSAN - University Of Buffalo
item NICHOLS, BUFORD - Children'S Nutrition Research Center (CNRC)
item GILGER, MAKR - Baylor College Of Medicine

Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/27/2017
Publication Date: 6/1/2018
Citation: Chumpitazi, B.P., Robayo-Torres, C.C., Tsai, C.M., Opekun, A.R., Baker, S.S., Nichols, B.L., Gilger, M.A. 2018. Demographic and clinical correlates of mucosal disaccharidase deficiencies in children with functional dyspepsia. Journal of Pediatric Gastroenterology and Nutrition. 66:S52-S55. https://doi.org/10.1097/MPG.0000000000001859.
DOI: https://doi.org/10.1097/MPG.0000000000001859

Interpretive Summary: A subset of children with functional gastrointestinal disorders may have duodenal disaccharidase deficiencies limiting carbohydrate digestion to glucose. We determined the frequency, demographics, and clinical characteristics associated with duodenal disaccharidase deficiencies in 129 children with functional dyspepsia. Forty-eight % of subjects in study 1 and 46% of subjects in study 2 had at least 1 disaccharidase deficiency identified. All of those with a disaccharidase deficiency in both studies had lactase deficiency with 8% and 18% of those in, having an additional disaccharidase deficiency. Hispanic (vs non-Hispanic, P<0.05) and non-white (vs white, P<0.01) children were more likely to have lactase deficiency. Multiple disaccharidase deficiency was found in approximately 6%. This study provides clarity of how common disaccharidase deficiency is in children and the need to address this concern through nutritional approaches.

Technical Abstract: A subset of children with functional gastrointestinal disorders (FGIDs), which includes functional dyspepsia, may have duodenal disaccharidase deficiencies. To determine the frequency, demographics, and clinical characteristics associated with duodenal disaccharidase deficiencies in children with functional dyspepsia. Children ages 4 to 18 years undergoing esophagogastroduodenoscopy (EGD) evaluation for dyspepsia were enrolled in either a retrospective (study 1) or prospective (study 2) evaluation. Those with histologic abnormalities were excluded. Duodenal biopsies were obtained for disaccharidase enzyme analysis. In the retrospective study, both demographic and clinical characteristics were obtained via chart review. In the prospective study, parents completed the Rome II Questionnaire on Gastrointestinal Symptoms before the EGD. One hundred and twenty-nine children (n=101, study 1; n=28, study 2) were included. Mean age was 11.2+/-3.8 (SD) years in study 1 and 10.6+/-3.2 years in study 2. Forty-eight (47.5%) of subjects in study 1 and 13 (46.4%) of subjects in study 2 had at least 1 disaccharidase deficiency identified. All of those with a disaccharidase deficiency in both studies had lactase deficiency with 8 (7.9%) and 5 (17.9%) of those in studies 1 and 2, respectively, having an additional disaccharidase deficiency. The second most common disaccharidase deficiency pattern was that of pan-disaccharidase deficiency (PDD) in both studies. In study 1 (where both race and ethnicity were captured), self-identified Hispanic (vs non-Hispanic, P<0.05) and non-white (vs white, P<0.01) children were more likely to have lactase deficiency. Age, sex, and type of gastrointestinal symptom were not associated with presence or absence of a disaccharidase deficiency. Approximately half of children with functional dyspepsia undergoing EGD were identified as having a disaccharidase deficiency (predominantly lactase deficiency). Race/ethnicity may be associated with the likelihood of identifying a disaccharidase deficiency. Other clinical characteristics were not able to distinguish those with versus without a disaccharidase deficiency.