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Diagnostic value of sucrose tolerance test in children evaluated by breath hydrogen measurement
Insights
Congenital sucrase-isomaltase deficiency is rare in children with digestive issues. The oral sucrose tolerance test is not recommended for screening secondary disaccharidase deficiencies.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Clinical Diagnostics
Background:
- Episodic diarrhea and abdominal pain are common in children.
- Disaccharide malabsorption, such as lactose intolerance, is a frequent cause.
- Congenital sucrase-isomaltase deficiency is a rare genetic disorder affecting sucrose digestion.
Purpose of the Study:
- To evaluate the utility of the oral sucrose tolerance test (OSTT) in diagnosing sucrose malabsorption in children presenting with gastrointestinal symptoms.
- To compare the diagnostic performance of OSTT with the lactose tolerance test (LTT) in this pediatric population.
- To determine the incidence of sucrose malabsorption in children with unexplained episodic diarrhea and/or abdominal pain.
Main Methods:
- 103 children (3 months–15 years) with episodic diarrhea/abdominal pain underwent OSTT.
- Expired hydrogen levels were measured to assess sucrose malabsorption.
- Results were compared with a previously established LTT incidence in the same cohort.
- Blood glucose response during both tests was analyzed.
Main Results:
- Only 3 children (1%) exhibited sucrose malabsorption, diagnosed as congenital sucrase-isomaltase deficiency.
- This incidence is significantly lower than lactose malabsorption (33%).
- OSTT showed a higher mean blood glucose rise and fewer false flat curves compared to LTT, indicating better diagnostic accuracy for sucrase deficiency.
Conclusions:
- Congenital sucrase-isomaltase deficiency is uncommon in children with these symptoms.
- The OSTT is not a suitable screening tool for secondary disaccharidase deficiencies in pediatric patients.
- Lactose malabsorption is a more prevalent issue in this symptomatic pediatric group.
Abstract:
An oral sucrose tolerance test was performed in a group of 103 children, aged between 3 months and 15 years because of episodic diarrhea and/or abdominal pains. Sucrose malabsorption defined as an abnormal increase in expired hydrogen, was found in only 3 children who suffered from congenital sucrase-isomaltase deficiency. This 1% incidence of sucrose malabsorption was lower than the incidence of lactose malabsorption found in this group (33%). Mean rise in blood glucose during the sucrose test was higher (3.4 +/- 1.4 vs. 2.4 +/- 1.2 mmol/l, p less than 0.0001) and the occurrence of false flat blood glucose curves was lower (3% vs. 12.8%, p less than 0.05) than during the lactose test. These findings are consistent with the higher sucrase activity in the small bowel mucosa compared to lactase. In contrast to the lactose tolerance test, sucrose tolerance test should not be used as a screening procedure for secondary disaccharidase deficiency in children.