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.
Dig Dis Sci. 2020 Feb;65(2):534-540. doi: 10.1007/s10620-019-05780-7. Epub 2019 Sep 6.
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.
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.
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.
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.
肠易激综合征（IBS）患者常伴有与进餐相关的症状，并能识别特定的触发食物。乳糖不耐受是一种已确立的碳水化合物吸收不良综合征，可引起与 IBS 相似的症状，如腹胀、腹痛和腹泻。然而，这种人群中蔗糖酶-异麦芽糖酶缺乏症（SID）的患病率尚未明确。SID 是一种由于小肠刷状缘产生的蔗糖酶-异麦芽糖酶（代谢蔗糖的酶）缺乏而导致的病症。与乳糖酶缺乏症一样，SID 会引起消化不良综合征的症状，包括腹痛、腹胀、气体和腹泻。在这项研究中，我们旨在确定推定的 IBS-D/M 患者中 SID 的患病率，并描述其临床表现。
纳入了根据腹痛、腹泻和/或腹胀症状进行了食管胃十二指肠镜检查和十二指肠活检及双糖酶缺乏检测的推定 IBS-D/M 患者。排除了有炎症性肠病、胃肠道恶性肿瘤或乳糜泻病史的患者。计算了有 SID 的患者与无 SID 的患者之间腹痛、腹泻和腹胀的比值比。
共纳入 31 例临床怀疑 IBS-D/M 的患者，中位年龄为 46 岁（IQR 30.5-60），女性占 61%。35%的患者存在 SID。SID 组中，63.6%有腹泻，45.4%有腹痛，36.4%有腹胀。SID 组患者腹痛的可能性低于对照组（比值比 0.16，95%CI 0.03-0.81，p=0.04），但腹泻或腹胀无差异。仅有 2 例 SID 患者进行了蔗糖呼气试验，其中仅 1 例结果阳性。然而，该患者也有葡萄糖呼气试验阳性，可能存在小肠细菌过度生长这一混杂因素。
在推定的 IBS-D/M 患者中发现 SID 占 35%，SID 应作为出现腹痛、腹泻或腹胀的患者鉴别诊断的考虑因素。进一步的研究应更好地描述 SID 的临床特征，并研究饮食改变对这组患者的影响。
