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Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens.

Abstract

OBJECTIVES

Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency.

METHODS

A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology.

RESULTS

One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value.

CONCLUSIONS

Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

Authors+Show Affiliations

Department of Laboratory Medicine and Pathology, Children's Hospitals and Clinics of Minnesota, Minneapolis.Department of Pathology, Microbiology & Immunology, Division of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN. Department of Laboratories, Seattle Children's Hospital, Seattle, WA. Department of Pathology, University of Washington, Seattle.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31332425

Citation

Reed, Robyn C., and M Cristina Pacheco. "Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens." American Journal of Clinical Pathology, 2019.
Reed RC, Pacheco MC. Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens. Am J Clin Pathol. 2019.
Reed, R. C., & Pacheco, M. C. (2019). Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens. American Journal of Clinical Pathology, doi:10.1093/ajcp/aqz091.
Reed RC, Pacheco MC. Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens. Am J Clin Pathol. 2019 Jul 23; PubMed PMID: 31332425.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens. AU - Reed,Robyn C, AU - Pacheco,M Cristina, Y1 - 2019/07/23/ PY - 2019/7/24/entrez KW - Disaccharidase KW - Duodenum KW - Laboratory management KW - Lactase KW - Sucrase KW - Sucrase-isomaltase deficiency JF - American journal of clinical pathology JO - Am. J. Clin. Pathol. N2 - OBJECTIVES: Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. METHODS: A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. RESULTS: One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. CONCLUSIONS: Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility. SN - 1943-7722 UR - https://www.unboundmedicine.com/medline/citation/31332425/Clinical_and_Histopathologic_Predictors_of_Disaccharidase_Deficiency_in_Duodenal_Biopsy_Specimens L2 - https://academic.oup.com/ajcp/article-lookup/doi/10.1093/ajcp/aqz091 DB - PRIME DP - Unbound Medicine ER -