Post by kickingfrog on Oct 17, 2016 10:33:39 GMT
THE ENZYME ACTIVITY OF SMALL INTESTINAL MUCOSA IN ADULT PATIENTS WITH CELIAC DISEASE.
E. Sabelnikova O. Ahmadullina N. Belostotsky A. Parfenov
Introduction
Some patients with celiac disease (CD), who have followed gluten-free diet (GFD) and have a normal histological structure of small intestine mucosa, may still have symptoms of bloating, rumbling and diarrhea. These symptoms may be associated with changes of the activity of the small intestine enzymes.
Objective: To determine the activity of enzymes (glucoamylase, maltase, sucrase and lactase) in CD patients.
Aims & Methods
Thirteen patients with newly diagnosed CD: 9 women and 4 men, (mean age 38,68 ± 15,75 years) and 30 patients with previously diagnosed CD: 22 women and 8 men (mean age 41,96 ± 18,46 years) were observed. The diagnosis of CD was based on clinical presentation, serology, including anti-gliadin antibodies (AGA) IgA and anti-tissue transglutaminase (anti-tTG) IgA antibodies and duodenal biopsy. Histological changes of intestinal biopsy were classified according to the revised Marsh criteria 1999. In 1 group Marsh IIIb lesions were seen in 23 %, Marsh IIIc – in 77 %. In 2 group - Marsh IIIa and Marsh IIIb lesions were seen in 30% respectively, Marsh II - in 13,3%, the normal structure of small intestine were observed in 26,6%. The enzyme activity was measured in small intestine mucosa by Dahlquist modified method.
Results
In patients with newly diagnosed CD, the activity of all enzymes was decreased in 92,3% in the group of patients followed GFD - in 36,5% (p < 0,05). It was found that the total atrophy (Marsh IIIc) was associated with a reduced activity of all enzymes in all patients; whereas all patients with Marsh IIIb atrophy had a decreased activity of lactase, 90% had a decreased activity of glucoamylase and maltase, and in 81,8% of cases we observed a decreased activity of sucrase. The recovery of the intestine mucosa showed improvement of activity of all enzymes. However, even in normal small intestine mucosa the reduction of glucoamylase activity was observed in 37,5% reduction of maltase activity - in 62,5%%, the activity of sucrase was reduced in 50% and activity of lactase was decreased in 37,5%. The reduced activity of all enzymes was found in 37,5% of patients with normal structure of small intestine mucosa. A weak correlation between the degree of atrophy and the activity of sucrase and maltase (rs = -0,513, p = 0,005 and rs = -0,406, p = 0,029, respectively) was established. Activity of other enzymes had no significant correlation with the degree of atrophy.
Conclusion
In 37,5% of adult patients with CD who follow GFD and have a normal structure of mucosa, a decreased activity of intestinal enzymes may occur, which may be one of the reasons for the persistence of intestinal symptoms.
cslide.ctimeetingtech.com/ueg2016/confcal/coeliac