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Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome.

Abstract

BACKGROUND

Patients with irritable bowel syndrome (IBS) frequently have meal-related symptoms and can recognize specific trigger foods. Lactose intolerance is a well-established carbohydrate malabsorption syndrome that causes symptoms similar to IBS such as bloating, abdominal pain, and diarrhea. However, the prevalence of sucrase-isomaltase deficiency (SID) in this population is poorly defined. SID is a condition in which sucrase-isomaltase, an enzyme produced by brush border of small intestine to metabolize sucrose, is deficient. Just like lactase deficiency, SID causes symptoms of maldigestion syndromes including abdominal pain, bloating, gas, and diarrhea. In this study, we aim to determine the prevalence of SID in patients with presumed IBS-D/M and characterize its clinical presentation.

METHODS

Patients with a presumed diagnosis of IBS-D/M based on symptoms of abdominal pain, diarrhea, and/or bloating who underwent esophagogastroduodenoscopy with duodenal biopsies and testing for disaccharidase deficiency were included. Patients with a history of inflammatory bowel disease, gastrointestinal malignancy, or celiac disease were excluded. Odds ratio was calculated for abdominal pain, diarrhea, and bloating in patients with versus without SID.

RESULTS

A total of 31 patients with clinical suspicion for IBS-D/M were included with a median age of 46 years (IQR 30.5-60) and with 61% females. SID was present in 35% of patients. Among patients with SID, 63.6% had diarrhea, 45.4% had abdominal pain, and 36.4% had bloating. Patients with SID were less likely than controls to have abdominal pain (OR 0.16, 95% CI 0.03-0.81, p = 0.04) although no difference in diarrhea or bloating was found. Only two patients with SID underwent sucrose breath testing of which only one had a positive result. However, this patient also had a positive glucose breath test and may have had small intestinal bacterial overgrowth as a confounder.

CONCLUSION

SID was found in 35% of patients with presumed IBS-D/M and should be considered in the differential diagnosis of patients presenting with abdominal pain, diarrhea, or bloating. Further studies should better characterize the clinical features of SID and investigate the effects of dietary modification in this group of patients.

Authors+Show Affiliations

Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.Division of Gastroenterology, Newton-Wellesley Hospital, 2000 Washington St, Suite 368, Newton, MA, 02462, USA.Department of Gastroenterology, University of Miami Miller School of Medicine, 1295 Northwest 14th Street, Miami, FL, 33125, USA.Department of Pathology, Jackson Memorial Health System, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA.Atrium Health, University of North Carolina, 1025 Morehead Medical Dr. Suite 300, Charlotte, NC, 28204, USA. Baha.Moshiree@atriumhealth.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31493040

Citation

Kim, Su Bin, et al. "Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome." Digestive Diseases and Sciences, 2019.
Kim SB, Calmet FH, Garrido J, et al. Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome. Dig Dis Sci. 2019.
Kim, S. B., Calmet, F. H., Garrido, J., Garcia-Buitrago, M. T., & Moshiree, B. (2019). Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome. Digestive Diseases and Sciences, doi:10.1007/s10620-019-05780-7.
Kim SB, et al. Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome. Dig Dis Sci. 2019 Sep 6; PubMed PMID: 31493040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome. AU - Kim,Su Bin, AU - Calmet,Fernando H, AU - Garrido,Jose, AU - Garcia-Buitrago,Monica T, AU - Moshiree,Baharak, Y1 - 2019/09/06/ PY - 2018/04/12/received PY - 2019/08/07/accepted PY - 2019/9/8/entrez KW - Abdominal pain KW - Bloating KW - Carbohydrate malabsorption KW - Diarrhea KW - Irritable bowel syndrome KW - Sucrase-isomaltase deficiency JF - Digestive diseases and sciences JO - Dig. Dis. Sci. N2 - BACKGROUND: Patients with irritable bowel syndrome (IBS) frequently have meal-related symptoms and can recognize specific trigger foods. Lactose intolerance is a well-established carbohydrate malabsorption syndrome that causes symptoms similar to IBS such as bloating, abdominal pain, and diarrhea. However, the prevalence of sucrase-isomaltase deficiency (SID) in this population is poorly defined. SID is a condition in which sucrase-isomaltase, an enzyme produced by brush border of small intestine to metabolize sucrose, is deficient. Just like lactase deficiency, SID causes symptoms of maldigestion syndromes including abdominal pain, bloating, gas, and diarrhea. In this study, we aim to determine the prevalence of SID in patients with presumed IBS-D/M and characterize its clinical presentation. METHODS: Patients with a presumed diagnosis of IBS-D/M based on symptoms of abdominal pain, diarrhea, and/or bloating who underwent esophagogastroduodenoscopy with duodenal biopsies and testing for disaccharidase deficiency were included. Patients with a history of inflammatory bowel disease, gastrointestinal malignancy, or celiac disease were excluded. Odds ratio was calculated for abdominal pain, diarrhea, and bloating in patients with versus without SID. RESULTS: A total of 31 patients with clinical suspicion for IBS-D/M were included with a median age of 46 years (IQR 30.5-60) and with 61% females. SID was present in 35% of patients. Among patients with SID, 63.6% had diarrhea, 45.4% had abdominal pain, and 36.4% had bloating. Patients with SID were less likely than controls to have abdominal pain (OR 0.16, 95% CI 0.03-0.81, p = 0.04) although no difference in diarrhea or bloating was found. Only two patients with SID underwent sucrose breath testing of which only one had a positive result. However, this patient also had a positive glucose breath test and may have had small intestinal bacterial overgrowth as a confounder. CONCLUSION: SID was found in 35% of patients with presumed IBS-D/M and should be considered in the differential diagnosis of patients presenting with abdominal pain, diarrhea, or bloating. Further studies should better characterize the clinical features of SID and investigate the effects of dietary modification in this group of patients. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/31493040/Sucrase-Isomaltase_Deficiency_as_a_Potential_Masquerader_in_Irritable_Bowel_Syndrome L2 - https://doi.org/10.1007/s10620-019-05780-7 DB - PRIME DP - Unbound Medicine ER -