Esra Eren, Fatma Demirbaş, Atakan Comba, Gönül Çaltepe, Ayhan Gazi Kalaycı, Özlem Yüce

Çölyak hastalarında ve sağlıklı çocuklarda laktoz malabsorbsiyonu

Amaç Laktoz malabsorbsiyonu, doğuştan, primer veya sekonder olarak ortaya çıkabilir. Çölyak hastalığı, sekonder laktoz malabsorbsiyona neden olan bir hastalıktır. Bu çalışmada, çölyak hastası çocuklar ile sağlıklı çocuklarda laktoz hidrojen nefes testi ile laktoz malabsorbsiyon sıklığının belirlenmesi amaçlanmıştır. Gereç ve Yöntem Çalışmaya, 64 çölyak hastası ve 52 sağlıklı çocuk dahil edildi. Çölyak hastaları yeni tanı alanlar ve takipli çölyak hastaları olarak iki gruba ayrıldı. Takipli çölyak hastaları tedaviye (glutensiz diyete) tam uyumlu olanlar ve tedaviye uyumsuz olanlar olarak iki grupta incelendi. Laktoz hidrojen nefes testi 0-500 ppm hidrojen seviyesini algılayabilen ve 1 ppm düzeyinde duyarlı gaz analiz cihazı kullanılarak yapıldı. Bulgular Çocukların ortalama yaşı 10,4 ± 4,5 yıldı. Çölyak hastalarının 16’sı yeni tanılı, 48’i takipli idi. Takipli çölyakların 24’ü (%50) glutensiz diyete tam uyumluydu. Yeni tanı çölyak hastalarının %62,5’inde, glutensiz diyete uyumsuz olanların %54,2’sinde, glutensiz diyete tam uyumluların %33,3’ünde, sağlıklı çocukların ise %19,2’sinde laktoz hidrojen nefes testi pozitifti. Yeni tanılı ve glutensiz diyete uymayan çölyak hastalarının laktoz hidrojen nefes testi pozitiflik oranı (sırasıyla, %62,5; %54,2), sağlıklı çocuklardan (%19,2) anlamlı olarak yüksekti (sırasıyla, p=0,002 ve p=0,003). Hem çölyak hastalarında hem de sağlıklı çocuklarda, laktoz hidrojen nefes testi pozitif olanların beden kitle indeksi z skoru, negatif olan çocuklardan anlamlı olarak düşüktü (p<0,001, p=0,041; sırasıyla). Sonuç Çalışmada, çölyak serolojisi pozitif olan hastalarda laktoz hidrojen nefes testi pozitifliği anlamlı olarak yüksek bulundu. Çölyak hastalığında laktoz hidrojen nefes testi ile laktoz malabsorbsiyon sıklığı ve mukozal hasar indirekt olarak saptanabilir. Laktoz malabsorbsiyonu, beden kitle indeksi düşük olan çocuklarda daha sık görülmektedir.

Anahtar Kelimeler:

çocuk, çölyak hastalığı, hidrojen nefes testi, laktoz malabsorbsiyonu

Lactose malabsorption in children with celiac disease and healthy children

Purpose. Lactose malabsorption (LM) can be congenital, primary, or secondary. Celiac disease (CD) is a secondary cause of lactose malabsorption. This study aimed to determine lactose malabsorption frequency using a lactose hydrogen breath test (LHBT) in children with celiac disease and healthy children. Materials and methods. The study included 64 children with CD and 52 healthy controls. Celiac patients were divided into groups as newly diagnosed and followed celiac patients. The latter were divided into groups as compliance or noncompliance with gluten-free diet (GFD). LHBT was performed using a gas analyser with a 1-ppm sensor sensitivity of hydrogen levels of 0–500 ppm.Results. Mean age of the children was 10.4 ± 4.5 years. Sixteen of the patients had newly diagnosed celiac disease, and 24 (50%) were compliant with GFD. LHBT results were positive in 62.5% of the newly diagnosed CD patients, 33.3% of those compliant with GFD, 54.2% of those non-compliant with GFD, and 19.2% of controls. A significantly higher proportion of newly diagnosed CD (62.5%) and non-compliant with GFD (54.2%) had positive LHBT results than controls (19.2%) (p=0.002 and p=0.003, respectively). The body mass index z scores of the children with LHBT positivity were significantly lower than others in both healthy children and children with CD (p<0.001, p=0.041, respectively). Conclusion. In our study, the frequency of LHBT positivity was significantly higher in celiac patients with positive celiac serology.LHBT identified mucosal damage as indirect in celiac disease. Lactose malabsorption is more common in children who have low body mass index.

Keywords:

child, celiac disease, hydrogen breath test, lactose malabsorption,

PDF

___

Kaynaklar1. Guandalini S, Setty M. Celiac disease. Curr Opin Gastroenterol 2008;24:707-712. doi: 10.1097/MOG.0b013e32830f4527.2. Kang JY, Kang AH, Green A, Gwee KA, Ho KY. Systematic review: Worldwide variation in the frequency of celiac disease and changes over time. Aliment Pharmacol Ther 2013;38:226-245. doi: 10.1111/apt.12373.3. Lionetti E, Catassi C. New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatment. Int Rev Immunol 2011;30:219-231. doi: 10.3109/08830185.2011.602443.4. Jadresin O, Misak Z, Sanja K, Sonicki Z, Zizić V. Compliance with gluten-free diet in children with coeliac disease J. Pediatr Gastroenterol Nutr 2008;47:344-348. doi: 10.1097/MPG.0b013e31816f856b.5. Murphy MS, Sood M, Johnson T. Use of the lactose H2 breath test to monitor mucosal healing in celiac disease. Acta Paediatr 2002;91:141-144.6. Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clin Exp Gastroenterol 2012;5:113-121. doi: 10.2147/CEG.S32368.7. Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics 2006;118:1279-1286. doi:10.1542/peds.2006-17218. Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice myths and realities. Aliment Pharmacol Ther 2008;27:93-103. doi:10.1111/j.1365-2036.2007.03557.x9. Castiglione F, Di Girolamo E, Ciacci C, et al. Lactose malabsorption: Clinical or breath test diagnosis? E Spen Eur E J Clin Nutr Metab 2008;3:e316e-e320. doi:10.1016/j.eclnm.2008.07.018.10. Vandenplas Y. Lactose intolerance. Asia Pac J Clin Nutr 2015;24:9-13. doi: 10.6133/apjcn.2015.24.s1.02.11. Däbritz J, Mühlbauer M, Domagk D, et al. Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption. BMC Pediatr 2014;14: 59. doi: 10.1186/1471-2431-14-59.12. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: time for a standardized report scheme for pathologists Eur J Gastroenterol Hepatol 1999;11:1185-1194.13. Gijsbers CF, Kneepkens CM, Büller HA. Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double-blinded testing. Acta Paediatr 2012;101:411-415. doi: 10.1111/j.1651-2227.2012.02721.x. 14. Babu J, Kumar S, Babu P, Prasad JH, Ghoshal UC. Frequency of lactose malabsorption among healthy southern and northern Indian populations by genetic analysis and lactose hydrogen breath and tolerance tests. Am J Clin Nutr 2010;91:140-146. doi: 10.3945/ajcn.2009.27946.15. Ojetti V, Nucera G, Migneco A, et al. High prevalence of celiac disease in patients with lactose intolerance. Digestion 2005;71:106-110. doi:10.1159/000084526.16. Kerber M, Oberkanins C, Kriegshäuser G, et al. Hydrogen breath testing versus LCT genotyping for the diagnosis of lactose intolerance: a matter of age. Clin Chim Acta. 2007;383:91-96. doi: 10.1016/j.cca.2007.04.028.17. Ojetti V, Gabrielli M, Migneco A, et al. Regression of lactose malabsorption in celiac patients after receiving a gluten-free diet. Scand J Gastroenterol 2008; 43: 174-177. doi:10.1080/00365520701676138.18. Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol 2003;98:839-843. doi:10.1111/j.1572-0241.2003.07379.x.19. Ghoshal UC, Ghoshal U, Misra A, Choudhuri G. Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. BMC Gastroenterol 2004;4:10. doi:10.1186/1471-230X-4-10.20. Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP. Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol 2007;5:445-450. doi: 10.1016/j.cgh.2006.12.00621. Moran S, Mina A, Duque X, et al. Prevalence of lactose malabsorption in Mexican children: importance of measuring methane in expired air. Arch Med Res 2013;44:291-295. doi: 10.1016/j.arcmed.2013.04.005.22. Hegar B, Widodo A. Lactose intolerance in Indonesian children. Asia Pac J Clin Nutr 2015;24:31-40. doi: 10.6133/apjcn.2015.24.s1.06. 23. Harvey L, Ludwig T, Hou AQ, et al. Prevalence, cause and diagnosis of lactose intolerance in children aged 1-5 years: a systematic review of 1995-2015 literature. Asia Pac J Clin Nutr 2018;27:29-46. doi: 10.6133/apjcn.022017.05.24. Kvissberg MA, Dalvi PS, Kerac M, et al. Carbohydrate malabsorption in acutely malnourished children and infants: a systematic review. Nutr Rev 2016; 74:48-58. doi: 10.1093/nutrit/nuv058.25. Nichols BL, Dudley MA, Nichols VN, et al. Effects of malnutrition on expression and activity of lactase in children. Gastroenterology 1997;112:742-751. 26. Braden B. Methods and functions: Breath tests. Best Pract Res Clin Gastroenterol 2009;23:337-352. doi: 10.1016/j.bpg.2009.02.014.27. Ruzsanyi V, Heinz-Erian P, Entenmann A, et al. Diagnosing lactose malabsorption in children: difficulties in interpreting hydrogen breath test results. J Breath Res 2016;10:016015. doi: 10.1088/1752-7155/10/1/016015.