Disaccharidase activity in children undergoing esophagogastroduodenoscopy: A systematic review

Table 1 Description of 13 studies examining intestinal disaccharides in children undergoing esophagogastroduodenoscopy with sample size less than 50

Ref.	Histology association between histology and disaccharidase activity	Other underlying condition	Sample size, % male	Age range, mean	Ethnicity	Lactase (μmol/min per gram)	Sucrase (μmol/min per gram)mean	Maltase(μmol/min per gram)mean	Palatinase (μmol/min per gram)mean
Disaccharidase values in iron-deficient infants (1981) Lanzkowsky et al[35] United States	No abnormalities	Severe nutritional iron deficiency anemia	10 (5 biopsied), sex not reported	8-30 mo, 14.9 mo	Not reported	Initial: 10 Post-iron treatment: 40	Initial: 140 Post-iron treatment: 230	Initial: 190 Post-iron treatment: 400	Not reported
Diamine oxidase and disaccharidase activities in small intestinal biopsies of children (1984) Forget et al[24] Belgium	No abnormalities	Bronchitis, vomiting, chronic diarrhea, failure to thrive	18, 61%	0.2-6 yr, 2.32 yr	Not reported	1.78 (measured in U/g wet weight)	4.34 (measured in U/g wet weight)	15.48 (measured in U/g wet weight)	Not reported
Dissacharidase deficiency in children with immunologic deficits (1970) Dubois et al[30] United States	Villous atrophy in two patients with idiopathic acquired hypogammaglobulinemia. No abnormalities in all other patients; Association not reported	Congenital hypogammaglobulinemia; Idiopathic acquired hypogammaglobulinemia; Isolated IgA deficiency; Thymic Dysplasia, Thymic alymphoplasia	18, 77.80%	3 mo-16 yr, 8.72 yr	Caucasian	14.2 (21 biopsies)	40.1 (20 biopsies)	150 (20 biopsies)	Not reported
Histologic findings are not correlated with disaccharidase activities in infants with protracted diarrhea (1991) Shulman et al[5] United States	Mucosal inflammation; No association	Diarrhea of approximately 2 wk, mild to severe malnutrition	21, sex not reported	1.0-6.0 mo, 2.5 ± 1.5 mo	Not reported	17.1	71.1	224.3	Not reported
Intestinal disaccharidase deficiency in children with coeliac disease (1966) Arthur et al[22] United Kingdom	Mucosal inflammation and increased cells in lamina propria; Association not reported	Coeliac disease, post-gastroenteritis, monosaccharide intolerance, and pancreatic hypoplasia	22, 50% Normal: 6 Celiac disease: 12 Miscellaneous conditions: 4	7 mo-10.58 yr, 2.84 yr	Not reported	3.17 (measured in U/g wet weight)	3.42 (measured in U/g wet weight)	9.98 (measured in U/g wet weight)	1.34 (measured in U/g wet weight)
Lactose absorption and mucosal disaccharidases in covalescent pellagra and kwashiorkor children (1971) Prinsloo et al[26] South Africa	No abnormalities	Kwashiorkor, classical pellagra without oedema	22, 68.18%	15 mo-12 yr, 8.758 yr	Bantu	5.28	50.4	173.5	Not reported
Intestinal disaccharidase and alkaline phosphatase activity in giadiasis (1984) Welsh et al[7] United States	Villous atrophy in two patients; No association	Giardiasis, diarrhea of 2 wk to 12 mo duration	23, 43%	11 mo-14 yr, 3.39 yr	Caucasian	46	82	269	Not reported
Moderate and severe protein energy malnutrition in childhood: Effects on jejunal mucosal morphology and disaccharidase activites (1983) Römer et al[25] Venezuela	Villous atrophy; Association not reported	Degrees of Malnutrition: I Degree (10%-24% deficit), II Degree (25%-39% deficit), III Degree (over 40% deficit), marasmic kwashiorkor	33, 60.60%	0.7-5.6 yr Mean not reported	Not reported	11.4	59	191.5	Not reported
Disaccharidase activities in jejunal fluid (1983) Aramayo et al[12] United Kingdom	Villous atrophy and parasitic infection; Association present for lactase, sucrase, and maltase	STVA, unspecified gastrointestinal symptoms	29, sex not reported	10 mo-14 yr, 5.9 yr	Not reported	3.67 (measured in U/g wet weight) (approximated from figure)	6.39 (measured in U/g wet weight) (approximated from figure)	23 (measured in U/g wet weight) (approximated from figure)	Not reported
Reinvestigation of lactose intolerant children: lack of correlation between continuing lactose intolerance and small intestinal morphology, disaccharidase activity, and lactose tolerance tests (1977) Harrison et al[8] United Kingdom	Mucosal inflammation and villous atrophy; No association	Secondary lactose intolerance	30, 69%	2-38 mo, 10.4 mo	Not reported	2.3 (data from 4 patients) (measured in U/g wet weight)	4.4 (data from 4 patients) (measured in U/g wet weight)	16.4 (data from 4 patients) (measured in U/g wet weight)	Not reported
Disaccharidases in coeliac disease (1983) Horvath et al[6] Hungary	Villous atrophy; No association	Confirmed and suspected coeliac disease	30, sex not reported	8 mo-10 yr, 2.4 yr	Not reported	2.1 (measured in U/g wet weight)	Not reported	16 (measured in U/g wet weight)	Not reported
Quantitative assay of disaccharidase activities of small intestinal mucosal biopsy specimens in infancy and childhood (1965) Townley et al[23] United States	Villous atrophy; Association not reported	Urinary tract infection, cystic fibrosis, diabetes mellitus, hepatosplenomegaly, hypoproteinemia, protein-losing enteropathy, anemia, celiac disease	36, 58.30%	1/12-16 11/12 yr, 3.62 yr	Not reported	1.91 (measured in U/g wet weight)	3.6 (measured in U/g wet weight)	13.2 (measured in U/g wet weight)	4.03 (measured in U/g wet weight)
Disaccharidase activities in dyspeptic children: Biochemical and molecular investigations of maltase-glucoamylase activity (2002) Karnsakul et al[3] United States	No abnormalities	Dyspepsia, abdominal pain, reflux, vomiting	44, 66.70%	0.5-18 yr, 9.5 yr	37 Caucasian (84%) 1 Hispanic (2%) 2 African (5%)	7.01 (data from 12 patients)	19.2 (data from 11 patients)	92.66 (data from 8 patients)	Not reported

Table 2 Description of 8 studies examining intestinal disaccharides in children undergoing esophagogastroduodenoscopy with sample size between 50 and 200

Ref.	Histology; association between histology and disaccharidase activity	Other underlying condition	Sample size, % male	Age range, mean	Ethnicity	Lactase (μmol/min per gram) mean	Sucrase (μmol/min per gram) mean	Maltase (μmol/min per gram) mean	Palatinase (μmol/min per gram) mean
Disaccharidase deficiency in pediatric patients with celiac disease and intact villi (2011) Mones et al[21] United States	Increased lymphocytes and crypt hypertrophy; Association not reported	Celiac disease	51 CD: 25, 54% Control: 26, 50%	Ranges not reported, CD: 11.3 yr Control: 12.3 yr	Not reported	11.6	34.1	104.7	7.25
Disaccharidase activities, jeujunal morphology, and carbohydrate tolerance in children with chronic diarrhea (1985) Calvin et al[14] United States	Villous atrophy; Association present for lactase, sucrase, and maltase	Chronic Diarrhea	88, sex not reported	1-16 yr, 25 mo	Not reported	23.7	56.3	214.6	Not reported
Brush border enzyme activities in relation to histological lesion in pediatric celiac disease (2008) Prasad et al[16] India	Villous atrophy; Association present for lactase, sucrase, and maltase	GERD, celiac disease	GERD: 29, 62.09% CD: 71, 60.56%	CD: 15 mo-14 yr, 6.0 yr Control: 18 mo-14 yr, 6.2 yr	North Indian	15.7	30.7	62.3	Not reported
Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology (1990) Langman et al[15] Australia	Mucosal inflammation and villous atrophy; Association present for lactase, sucrase, and maltase	Suspected celiac disease, giardiasis, diarrhea, weight loss, abdominal pain, low folate concentrations	100, 41%	7-76 yr, Four patients under 15 yr, data is from all pts including adults 39 yr	98 Caucasian (98%) 1 African (1%) 1 Indian (1%)	5.7	16	28.5	Not reported
Glucoamylase and dissacharidase activities in normal subjectsand in patients with mucosal injury of the small intestine (1980) Lebenthal et al[29] United States	Villous atrophy; Association present for lactase, sucrase, maltase, and palatinase	Chronic diarrhea, failure to thrive	124, sex not reported	1 mo-18 yr, mean not reported	Not reported	19.7	42.4	141	10.8
Disaccharidase activity in infants and comparison based on symptoms and histological changes (2007) Tori et al[11] United States	Villous atrophy; Association present for lactase, sucrase, maltase, and palatinase	Diarrhea, failure to thrive	131, 57%	20 d-364 d, 180 d	111 Caucasian (85%) 14 African (11%)	29.2	42.1	138.2	10
Correlation of Lactase activity, lactose tolerance and milk consumption in different age groups (1975) Lebenthal et al[10] United Kingdom	No abnormalities	Failure to thrive with no organic cause, irritable colon syndrome	160 sex not reported	6 wk-50 yr, mean not reported	6 Other (4%) Caucasian	29.8	56.2	189.6	15.5
Intestinal Disaccharidase activity in patients with autism (2011) Kushak et al[20] United States	Mucosal inflammation (6%); Association present for lactase.	Autism (abdominal pain, flatulence, constipation, vomiting, weight loss, food allergy, suspected GERD)	199, 82.40%	22 mo-28 yr, 5.75 yr	195 Caucasian (98%) 2 Asian (1%) 2 Indian (1%)	14.7	45.6	209.2	Not reported

GERD: Gastroesophageal reflux disease.

Table 3 Description of 9 studies examining intestinal disaccharides in children undergoing esophagogastroduodenoscopy with sample size greater than 200

Ref.	Histology; association between histology and disaccharidase activity	Underlying condition/symptoms	Sample size, % male	Age range, mean	Ethnicity	Lactase (μmol/min per gram) mean	Sucrase (μmol/min per gram) mean	Maltase (μmol/min per gram) mean	Palatinase (μmol/min per gram) mean
Ethnic differences in intestinal disaccharidase values in children in Finland (2000) Kolho et al[28] Finland	No abnormalities	Abdominal pain, vomiting, suspected celiac disease, suspected inflammatory bowel disease, asthma, constipation, diarrhea, feeding problems, anemia, other	223, 55.20%	Finnish: 0.2-18 yr, median: 8.0 yr African: 1-13 yr, median: 5.0 yr Other: 4.5-15 yr, median: 12 yr	188 Finnish (84%) 27 African (12%) 8 other (4%)	23.4	48.1	186.3	Not reported
Intestinal lactase, sucrase, and alkaline phosphatase in 373 patients with coeliac disease (1984) O’Grady et al[17] Ireland	Mucosal inflammation; Association present for lactase and sucrase	Celiac disease	230 sex not reported	1-18 yr, Mean not reported	Not reported	14.05 (data from 45 patients)	33.9 (data from 45 patients)	Not reported	Not reported
Disaccharidase activities in children: Normal values and comparison based on symptoms and histological changes (1999) Gupta et al[9] United States	Villous atrophy; Association present for lactase, sucrase, maltase, and palatinase	Group 1: Recurrent abdominal pain, vomiting, gastroesophageal reflux, hematemesis, failure to thrive Group 2: All had diarrhea (included patients with celiac disease, inflammatory bowel disease, parasitic infestation, and congenital sucrase-isomaltase deficiency)	232, 47.80%	0.08-17 yr 5.9 yr	Not reported	18.3	37.9	169.1	12.7
Disaccharidase activities in small intestinal mucosa in patients with cystic fibrosis (1978) Antonowicz et al[19] United States	Villous atrophy; Association present for lactase	Cystic fibrosis Chronic diarrhea, failure to thrive, abdominal pain, vomiting, crying baby, other	240 sex not reported	Range and mean not reported	Caucasian	31.1	64	241	19.8
Disaccharidase activites in Belgian children: Reference intervals and comparison with non- Belgian Caucasian children (2003) Blomme et al[13] Belgium	Mucosal inflammation and villous atrophy; Association present for lactase, sucrase, and maltase		185 60.50%	Belgian: 0.1-12 yr, Median: 1.3 yr Caucasian: 0.2-8 yr, Median: 1.3 yr	151 Belgian (82%) 34 non-Belgian Caucasian (18%)	(median values) Group A: 40 (6-122) Group B: 28 Group C: 7 Non-Belgian: 33 (5-70)	(median values) Group A: 69 (18-184) Group B: 54 Group C: 25 Non-Belgian: 63 (10-125)	(median values) Group A: 208 Group B: 181 Group C: 96 Non-Belgian: 186	Not reported
Intestinal Disaccharidase Activites in Relation to Age, Race, and Mucosal Damage (1978) Welsh et al[7] United States	No abnormalities	Mucosal damage	399 sex not reported	1 mo-93 yr, mean not reported	339 Caucasian (85%) 53 African (13%)	35.9	76.5	262.2	26.6
“Normal” disaccharidase levels in children (1988) Barnes et al[34] Australia	No abnormalities	Failure to thrive, chronic diarrhea, short stature, family history of celiac disease, iron deficiency anemia, food hypersensitivity	580 sex not reported	0-12 yr, mean not reported	7 Native American (2%) Not reported	3.9 (measured in U/g wet weight)	6.4 (measured in U/g wet weight)	19.1 (measured in U/g wet weight)	Not reported
Human intestinal disaccharidase activities: Correlations with age, biopsy technique, and degree of villus atrophy (1991) Heitlinger et al[18] United States	Mucosal inflammation and villous atrophy; Association present for lactase and maltase	Not reported	798 sex not reported	0-18 yr, Mean not reported	Not reported	23.3	52.5	145.8	11.6
Frequency of sucrase deficiency in mucosal biopsies (2012) Nichols et al[4] United States	Not reported	Not reported	27875 % male not reported	0-93.5 yr, 11 yr	Not reported	21.8	56.5	167.6	11.3