Friday, 23 September 2011

Disaccharidase levels in coeliac disease

It tends to happen. You have a particular study or topic on your mind and all of a sudden other related material seems to magically appear alongside it. Take for example my recent posts on carbohydrate metabolism and autism. Following on from some other related work published a few months back, the digestion (or problems with the digestion) of carbohydrates seems to be a rising point of interest in relation to some cases of autism. One would by the very least expect more research to be done in this area.

Then yesterday (22/09/11) this paper by Mones and colleagues* appears looking at the levels of disaccharidases in people with coeliac (celiac) disease (CD). I must admit that I don't have the full-text of the paper at present so am very much working on the summary abstract. What I gather from that information to hand is that disaccharidase deficiency seemed to be a fairly common issue in pediatric cases of CD examined by Mones; where the degree of damage to the villi, as scored using the Marsh criteria, is perhaps not as severe as partial or full villous atrophy. Indeed Mones and co. reported significant reductions in lactase, sucrase, maltase and palatinase in Marsh I/II categorised patients with CD.

Mones presented cases where the level of immunopathology was relatively slight (compared with the nuclear wasteland of Marsh IV pathology) yet overall carbohydrate metabolism was significantly impaired.  It has long been known that CD shows more than a passing relationship to disaccharidase deficiency and that the level of deficiency seems to increase according to the level of mucosal damage.

It is also fast becoming recognised that outside of what might be called 'classical' CD, there seems to be a 'spectrum' of gluten sensitivity which does not follow normal CD diagnostic markers yet still may benefit from the implementation of a gluten-free diet. The intestinal pathology accompanying these gluten spectrum conditions remains a little bit of a mystery but on the basis of what is being seen in CD and also in recent days, autism, perhaps there are a few clues as to what and where we should be looking.

* Mones RL. et al. Disaccharidase deficiency in pediatric patients with celiac disease and intact villi. Scandinavian Journal of Gastroenterology. September 2011.