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P1282 - Disaccharidase Dilemma in Adults: Utility of Routine Assays in Diagnostic Upper Endoscopies

Monday, October 28

10:30 AM - 4:15 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Presenting Author(s)

NV

Nikhil Vasireddi

Case Western Reserve University
Cranbury, New Jersey

Neal Vasireddi¹, Nikhil Vasireddi², Nidah S. Khakoo, MD³, Keerthana Kasi, BS⁴, Arul Ruthwik Duggimpudi⁵, Haig Minassian, MD⁶, Srinivas S. Vasireddi, MD⁵

¹Cornell University, Ithaca, NY; ²Case Western Reserve University, Cranbury, NJ; ³University of Miami, Jackson Memorial Hospital, Miami, FL; ⁴International American University College of Medicine, Morganville, NJ; ⁵Advanced Digestive Center, Inc., Metuchen, NJ; ⁶Holmdel, NJ

Introduction: Disaccharidase assay for evaluating abdominal pain has been well studied in the pediatric population. Deficiency of lactase or sucrase-isomaltase can present with chronic diarrhea, flatulence, abdominal pain, and bloating in such patients. However, the prevalence of disaccharidase deficiencies in adult populations with such symptoms has not been well delineated.

Methods: Distal duodenal specimens from 100 patients with above symptoms, who underwent an upper endoscopy (EGD) at an outpatient facility were submitted for disaccharidase assay. Standardized laboratory cut off values were used to determine disaccharidase levels that were outside the normal range. Statistical analysis was done to determine the frequencies of abnormal disaccharidases. Analysis of the group, with normal or low lactase/sucrase and presenting clinical features, was performed.

Results: Mean age of study patients was 52 years and 46% of the patients were male. The racial distribution was as follows: 45% White, 23% Hispanic, 18% Asian, 6% Black, 8% other. Table 1 shows the frequencies of normal and low values for these patients. 84% of the cohort had low lactase, 21% had low sucrase, and 11% had all 4 values in normal range. Figure 2 shows the distribution of the remaining patients who had at least 1 abnormal disaccharide.

Discussion: The association between abdominal symptoms and carbohydrate malabsorption in adults is widely recognized, but testing is rarely performed by gastroenterologists in clinical practice. Dietary recommendations are often made empirically. We investigated the prevalence of low disaccharidase levels in the adult population with above symptoms. Besides lactase deficiency, a significant number of patients also had deficiency of sucrase, maltase and palatinase. While this study cannot establish a causal relationship between low levels noted and patient symptoms, this information can be used to recommend appropriate diets or the use of lactase and sucrase enzyme supplements offering a more selective approach in patient care.

Table 1. Frequency of Normal and Low Disaccharidases in Patients With Chronic Abdominal Pain (n=100). The cutoff points for each disaccharidase's activity were 10.00 umol/g/min for lactase, 25.00 umol/g/min for sucrase, 100.00 umol/g/min for maltase, and 9.00 umol/g/min for palatinase.

Figure 2. Distribution of normal and abnormal disaccharidase levels.

Disclosures:

Neal Vasireddi indicated no relevant financial relationships.

Nikhil Vasireddi indicated no relevant financial relationships.

Nidah Khakoo indicated no relevant financial relationships.

Keerthana Kasi indicated no relevant financial relationships.

Arul Ruthwik Duggimpudi indicated no relevant financial relationships.

Haig Minassian indicated no relevant financial relationships.

Srinivas Vasireddi indicated no relevant financial relationships.

Citation: Neal Vasireddi; Nikhil Vasireddi; Nidah S. Khakoo, MD; Keerthana Kasi, BS; Arul Ruthwik Duggimpudi; Haig Minassian, MD; Srinivas S. Vasireddi, MD. P1282 - DISACCHARIDASE DILEMMA IN ADULTS: UTILITY OF ROUTINE ASSAYS IN DIAGNOSTIC UPPER ENDOSCOPIES. Program No. P1282. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.