Disaccharidase deficiency under the guise of functional bowel disease

Background. Disaccharidase deficiency and functional bowel disorders (FBDs) are largely similar in clinical manifestations and require differential diagnosis due to different pathogenetic approaches to treatment. Objective. To assess the activity of disaccharidases of the mucous membrane of the small intestine in patients with clinical symptoms of FBDs. Methods. 102 patients aged from 18 to 50 years (41 men and 61 women) with clinical symptoms of irritable bowel syndrome (IBS) with a predominance of diarrhea (35 patients), IBS with a predominance of constipation (16), mixed type IBS of (14), functional diarrhea (33) and functional constipation (4) were examined. Disaccharidase activity was evaluated using Dalquist method modified by Trinder in duodenal biopsy specimens obtained during esophagogastroduodenoscopy. Results. Normal enzyme activity was detected in 11 (10.8%) patients. The activity of all the enzymes studied was reduced in 33 (32.3%) patients. In 58 (56.9%) patients, selective reduction in carbohydrase level was found. The basis for the treatment of patients with disaccharidase deficiency was a low-carb diet, intestinal antiseptics and enteroprotectors, which reduced clinical symptoms and increased the activity of membrane enzymes. Conclusion. In 89.2% of patients, the symptoms characteristic of FBDs were associated with a decrease in the activity of membrane enzymes of the small intestine. The reason for the enzymatic deficiency can include prior acute intestinal infections, the use of nonsteroidal anti-inflammatory drugs or other agents that damage the mucous membrane of the small intestine. Treatment with low-carb diet, intestinal antiseptics and enteroprotectors helps to stop pain, abdominal discomfort, flatulence and stool disorders.

functional bowel disorders, irritable bowel syndrome, mucous membrane of the small intestine, disaccharidase deficiency, enteroprotectors