Is Disaccharidase Deficiency in Pediatric Patients with Graft- Versus-Host Disease (Gvhd) a Contributing Cause for Diarrhea? - Abstract
Objectives: Graft versus host disease (GVHD) is the most common cause of diarrhea in allogeneic hematopoietic progenitor cell transplant (HPCT) recipients. Diarrhea may be caused by infection or epithelial cell damage secondary to chemotherapy or radiation, which in turn can decrease brush border
enzyme activity. Disaccharidase levels and the potential for lactose malabsorption as a contributing factor for diarrhea have not been studied in patients with GVHD. The aim of this study is to evaluate the prevalence of disaccharidase deficiency in pediatric HPCT patients with GVHD and its potential role in causing diarrhea.
Methods: A retrospective review of 21 HPCT patients with protracted diarrhea referred for gastrointestinal endoscopy and biopsy to rule out GVHD. Biopsies were evaluated for infection, GVHD, or other abnormalities. Duodenal samples were frozen and sent for disaccharidase analysis.
Results: One patient was excluded from the study because disaccharidase analysis was not sent. Grade 1 GVHD was found in 11 patients (55%), grade 2 in 1 patient (.05%), and no GVHD in the remaining 8 patients (40%). Ten patients with GVHD (83%) and 6 without (75%) had an isolated lactase deficiency (p =0.27). Six patients had virus present on intestinal biopsies and 1 patient had C. Difficile infection.
Conclusions: There is not a greater prevalence of either isolated lactase or global disaccharidase deficiency in pediatric HPCT patients with Grade 1 or 2 GVHD. However, regardless of presence of GVHD, the majorities of HPCT patients with protracted diarrhea have isolated lactase deficiency and may benefit from a lactose-free diet.