Selective lactase deficiency is common in pediatric patients undergoing upper endoscopy

Abstract

Lactase deficiency can lead to significant symptoms in the pediatric population. To date, few studies have examined the prevalence of enzyme testing-based lactase and other disaccharidase deficiencies (DDs) in pediatric patients undergoing upper endoscopic evaluation. The primary objective of this study was to determine the prevalence of selective lactase and other DDs amongst a large cohort of pediatric patients with and without inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis) via a chart review of 739 patients who underwent esophago-gastro-dudenoscopy EGD between April 2010 and August 2016. We identified 560 pediatric patients (ages 1-18 years) who underwent mucosal enzyme testing at the time of their EGD. The overall rate of lactase deficiency (LD) was 39%. LD positively correlated with age (p=0.00017), but there was no significant difference between age matched IBD and non-IBD patients (45% vs. 42% p=0.68). Four patients (0.17%) were found to have selective maltase deficiency. No selective sucrase or palatinase deficiency was identified. Statistically significant differences occurred in lactase deficiency amongst patients of different races. In conclusion, lactase deficiency is a relatively common finding in children undergoing EGD though at no increased rate amongst the IBD patient population. Disaccharidase testing should be considered in pediatric patients undergoing EGD.

Figure 1.

Correlation between age and lactase levels. Lactase levels had a significant negative correlation with age (R= −0.158 p= 0.00017).

Figure 2.

Distribution of lactase deficiency by patient race. There was a significant (p=7.56×10⁻¹¹ ) race dependent variation in lactase activities by ANOVA. Fischer exact testing for Asian to African American (p=0.4144), Asian to Caucasian (p<0.0001), Asian to Hispanic (p=0.6086), African American to Caucasians (p<0.0001), Black to Hispanic (p=0.1544) and Caucasians to Hispanic (p<0.0001).

Figure 3.

Average lactase levels in patients younger than age 5 amongst various ethnic groups (N= 25 in Hispanic group; N=68 in Caucasian group; N=14 in Asian group). Again, there was a significant (p=0.0078) race dependent variation in lactase levels by ANOVA. Student T testing for Asian to African American (p=0.023), Asian to Caucasians (p=0.291), Asian to Hispanic (p=0.003), African American to Caucasians (p=0.030), African American to Hispanic (p=0.405) and Caucasians to Hispanic (p=0.003).