Lactase activity as a limiting factor in the use of dairy products in children with celiac disease
L.Ya. KLIMOV1, M.V. STOYAN1,2, L.M. ABRAMSKAYA1, V.A. KURYANINOVA1,2, V.S. KASHNIKOV1,2, L.D. KOCHNEVA1, D.V. BOBRYSHEV1, A.N. KASYANOVA1, G.S. ANISIMOV3
1Stavropol State Medical University, 310 Mir Str., Stavropol, Russian Federation, 355017
2Municipal Children’s Clinical Hospital named after G.K. Filippskiy, 5 Ponomarev Str., Stavropol, Russian Federation, 355002
3North-Caucasus Federal University, 1 Pushkin Str., Stavropol, Russian Federation, 355009
Klimov L.Ya. ― Cand. Med. Sc., Head of the Department of Faculty Pediatrics, tel. +7-928-963-02-61, e-mail: klimov_leo@mail.ru
Stoyan M.V. ― Cand. Med. Sc., Assistant of the Department of Faculty Pediatrics, gastroenterologist, tel. +7-928-244-79-90, e-mail: marina-stoyan@mail.ru
Abramskaya L.M. ― postgraduate student of the Department of Faculty Pediatrics, tel. +7-938-346-88-96, e-mail: mila-alm@mail.ru
Kuryaninova V.A. ― Cand. Med. Sc., Assistant of the Department of Children’s Diseases Propedeutics, gastroenterologist, tel. +7-928-293-80-69, e-mail: vichkak@mail.ru
Kashnikov V.S. ― D. Med. Sc., associate Professor of the Department of Polyclinic Pediatrics, Chief Doctor, tel. (8652) 71-87-39, e-mail: 721771@mail.ru
Kochneva L.D. ― 4th year student of Pediatrics Faculty, tel. +7-905-442-03-67, e-mail: kochneva.lyubov.96@mail.ru
Bobryshev D.V. ― Cand. Med. Sc., Head of the Center for Personalized Medicine of Scientific-Innovative Association, tel. +7-962-403-41-77, e-mail: bobryshevRG@yandex.ru
Kasyanova A.N. ― 6th year student of Pediatrics Faculty, tel. +7-962-005-56-93, e-mail: a.nicolaevnakasjanova@yandex.ru
Anisimov G.S. ― Cand. Tech. Sc., Head of the Center for Technological Bio-engineering, tel. +7-962-447-84-25, e-mail: ags88@mail.ru
The article presents the results of the express-method research of the lactase activity in the biopsy of the jejunum mucosa in 50 children with celiac disease, among which 18 (36.0%) were in the acute period and 32 (64.0%) kept a gluten-free diet. Hypolactasia was diagnosed in 75.0% of cases, and its frequency did not significantly differ in children depending on the stage of the disease. The maximum degree of mucosal atrophy of the jejunum (Marsh 3C) was observed in 47.8% of patients with severe hypolactasia. Titer of autoantibodies to transglutaminase (anti-tTG IgA and IgG) is positively correlated with the severity of hypolactasia in children with celiac disease.
Key words: hypolactasia, lactose, coeliac disease, children, gluten-free diet.
REFERENCES
- All-Russian consensus on the diagnosis and treatment of celiac disease in children and adults. Consilium Medicum. Pediatriya (Appl.), 2016, no. 1, pp. 6-19 (in Russ.).
- Tseliakiya u detey, pod red. S.V. Bel’mera, M.O. Revnovoy [Celiac disease in children. Ed. by S.V. Belmer, M.O. Revnova]. Moscow: ID “Medpraktika-M”, 2013. 416 p.
- Banina T.V., Khaustova G.G., Shcheplyagina L.A. et al. Bone mineral density in patients with celiac disease. Ross. pediatr. zhurn, 2007, no. 2, pp. 54-55 (in Russ.).
- Jankowiak C., Ludwig D. Frequent causes of diarrhea: celiac disease and lactose intolerance. Med. Klin (Munich), 2008, vol. 103, no. 6, pp. 413-422.
- Ziatdinova N.V., Fayzullina R.A. Lactase deficiency in children. Prakticheskaya meditsina, 2010, no. 3 (42), pp. 44-47 (in Russ.).
- Matthews S.B., Waud J.P., Roberts A.G. et al. Systemic lactose intolerance: a new perspective on an old problem. Postgrad. Med. J, 2005, vol. 81, no. 953, pp. 167-173.
- Vandenplas Y. Lactose intolerance. Asia Pac. J. Clin. Nutr, 2015, vol. 24, pp. 9-13.
- Malterre T. Digestive and nutritional considerations in celiac disease: could supplementation help? Altern. Med. Rev, 2009, vol. 14, no. 3, pp. 247-257.
- Radlovic N., Mladenovic M., Lekovic Z. et al. Lactose intolerance in infants with gluten-sensitive enteropathy: frequency and clinical characteristics. Srp. Arh. Celok. Lek, 2009, vol. 137, no. 1-2, pp. 33-37.
- Colston K.W., Mackay A.G, Finlayson C. et al. Localisation of vitamin D receptor in normal human duodenum and in patients with coeliac disease. Gut, 1994, vol. 35, no. 9, pp. 1219-1225.
- Mal’tsev S.V., Arkhipova N.N., Shakirova E.M. Vitamin D, kal’tsiy i fosfaty u zdorovykh detey i pri patologii [Vitamin D, calcium and phosphate in healthy children and in pathology]. Kazan, 2012. 120 p.
- Banina T.V. Kostnaya mineral’naya plotnost’ u detey s tseliakiey v zavisimosti ot vyrazhennosti morfologicheskikh izmeneniy: avtoref. dis. … k.m.n [Bone mineral density in children with celiac disease, depending on the severity of morphological changes. Synopsis of dis. PhD med. sciences]. Moscow, 2007. 24 p.
- Shcheplyagina L.A., Banina T.V., Mukhina Yu.G. et al. Bone mineral density in children with celiac disease. Vopr. prakt. pediatrii, 2008, vol. 3, no. 2, pp. 22-26 (in Russ.).
- Krupa-Kozak U. Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment. Nutrition, 2014, vol. 30, no. 1, pp. 16-24.
- Mora S., Barera G. Bone mass and bone metabolism in pediatric gastrointestinal disorders. J. Pediatr. Gastroenterol. Nutr, 2004, vol. 39, no. 2, pp. 129-140.
- Selby R.L., Davies M., Adams J.E. et al. Bone loss in celiac disease is related to secondary hyperparathyroidism. J. Bone Miner. Res, 1999, vol. 14, no. 4, pp. 652-657.
- Khramtsova S.N., Shcheplyagina L.A. Hormonal regulation of bone mineralization. Ross. pediatr. zhurnal, 2006, no. 1, pp. 37-39 (in Russ.).
- Bavykina I.A. Nutritivnyy status i optimizatsiya dietoterapii u detey s neperenosimost’yu glyutena: avtoref. dis. … k.m.n [Nutritional status and optimization of diet therapy in children with gluten intolerance. Synopsis of dis. PhD med. sciences]. Voronezh, 2016. 23 p.
- Zakharova I.N., Sugyan N.G. Lactase deficiency in children and ways of its correction. Consilium Medicum. Pediatriya (Pril.), 2007, no. 1, pp. 75-80 (in Russ.).
- Klimov L.Ya. Tolerance to lactose children with chronic gastroduodenal diseases. Eksperimental’naya i klinicheskaya gastroenterologiya, 2003, no. 2, pp. 99-104 (in Russ.).
- Husby S., Koletzko S., Korponay-Szabo I.R. et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J. Pediatr. Gastroenterol. Nutr, 2012, vol. 54, no. 1, pp. 136-160.
- Pfefferkorn M.D., Fitzgerald J.F., Croffie J.M. et al. Lactase deficiency: not more common in pediatric patients with inflammatory bowel disease than in patients with chronic abdominal pain. J. Pediatr. Gastroenterol. Nutr, 2002, vol. 35, no. 3, pp. 339-343.
- Pawłowska K., Umławska W., Iwańczak B. Prevalence of lactose malabsorption and lactose intolerance in pediatric patients with selected gastrointestinal diseases. Adv. Clin. Exp. Med, 2015, vol. 24, no. 5, pp. 863-871.
- Nieminen U., Kahri A., Savilahti E. et al. Duodenal disaccharidase activities in the follow-up of villous atrophy in coeliac disease. Scand. J. Gastroenterol, 2001, vol. 36, no. 5, pp. 507-510.
- Mones R.L., Yankah A., Duelfer D. et al. Disaccharidase deficiency in pediatric patients with celiac disease and intact villi. Scand. J. Gastroenterol, 2011, vol. 46, no. 12, pp. 1429-1434.
- Parfenov A.I., Akhmadullina O.V., Sabel’nikova E.A. et al. Сarbohydrases activity as a marker for recovery of small intestinal mucosa in patients with celiac disease. Ter. arkhiv, 2015, vol. 87, no. 2, pp. 24-29 (in Russ.).
- Ojetti V., Gabrielli M., Migneco A. et al. Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet. Scan. J. Gastroenterol, 2008, vol. 43, no. 2, pp. 174-177.