DISACCHARIDASE MEASUREMENT IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE

Background: A recent study reported that 22% of the children with Inflammatory Bowel Disease (IBD) had duodenal abnormalities (JPGN 2004;39:257-61). Children with IBD are often advised to avoid dairy products, although the true prevalence of lactase deficiency is not known. Aims: 1. To estimate the prevalence of lactase and other disaccharidase deficiencies in patients with newly diagnosed IBD. 2. To assess that whether or not the duodenal histological changes correlate with the enzyme activities in children with IBD. Methods: 159 Children with the newly diagnosed IBD (Crohn's, n = 124; UC, n = 35; age: 12.4 ± 2.9yrs; 67 female; 14 African American, 119 Caucasian) had disaccharidase assays from duodenal biopsies. Duodenal histological changes and enzyme values (<3% of normal) were reviewed. All children with Celiac Disease were excluded from the General (G; n = 2192) and Age-Matched (AM; n = 159) controls. Results: The table shows the prevalence of decreased enzyme activities (%). There was no correlation between duodenal pathologies and decreased enzyme activities, and 60% of the children with low lactase had no histological changes. This study revealed that half of the children with IBD had decreased lactase activity that is similar then age-matched control patients undergoing EGD. Deficiency of the other disaccharidases was found to be more prevalent in the IBD groups than controls.TableConclusions: Inflammatory bowel disease (IBD) in childhood is often diagnosed at a vulnerable time of growth. Lactase deficiency may contribute to symptoms in IBD patients, prompting the recommendation of dietary restriction of whole milk and possibly escalating to an already elevated risk for osteopenia. Instead, a low lactose diet or enzyme replacement should be considered to ensure adequate calcium intake.