Disaccharidase Deficiency Research Articles

S765 Clinical Insights Into Disaccharidase Deficiency: Prevalence, Intestinal Histology, and Outcomes at a Tertiary Care Center

S765 Clinical Insights Into Disaccharidase Deficiency: Prevalence, Intestinal Histology, and Outcomes at a Tertiary Care Center

Disaccharidase deficiencies and gastrointestinal symptoms in patients referred to gastroscopic examination: a single center study from Norway

Objective Gastrointestinal illnesses have been reported in relation to low disaccharidase activity, yet both the prevalence of disaccharidase deficiency and its association with gastrointestinal symptoms and irritable bowel syndrome (IBS) are largely unknown. We aimed to determine the association between low activity of disaccharidase enzymes on gastrointestinal symptoms and presence of IBS. Methods Patients referred for gastroscopic examination due to gastrointestinal complaints were consecutively included. A pinch biopsy was taken from the distal part of duodenum, and disaccharidase activity was measured using the Dahlqvist method. Gastrointestinal symptom severity was measured using IBS-Symptom Severity Score (IBS-SSS). Results A total of 40 patients were included. Disaccharidase deficiency was detected in 24 patients (60%). Half of the patients (n = 21) had IBS according to Rome IV criteria. A majority (75%) of all patients reported moderate to severe gastrointestinal symptoms. Moderate to severe gastrointestinal symptoms were reported by 16 patients (67%) with disaccharidase deficiency and in 14 patients (88%) with normal disaccharidase activity. Lactase deficiency was detected in 22 patients (55%), maltase deficiency in 11 patients (28%), sucrase deficiency in 9 patients (23%), isomaltase deficiency in 13 patients (33%) and glucoamylase deficiency in 12 patients (30%). The activity of all enzymes was reduced in 8 patients (20%). Degree of disaccharidase deficiency was not associated with either the severity of gastrointestinal symptoms or the diagnosis of IBS. Enzymes levels were not associated with gastrointestinal symptom scores. Conclusion Our findings did not reveal any association between biochemically measured disaccharidase deficiency and gastrointestinal symptoms or the presence of IBS.

Congenital Sucrase-Isomaltase Deficiency: Same Mutation with Different Clinical Presentations.

Congenital sucrase-isomaltase deficiency is an autosomal recessive inherited disaccharidase deficiency characterized by chronic osmotic diarrhea. In this study, the genotype-phenotype relationships of close relatives of an index case with congenital sucrase-isomaltase deficiency were investigated. A 23-month-old female patient with a sucrase-isomaltase gene c.317G>A (p.C106Y) homozygous mutation was diagnosed as an index case and her pedigree analysis was performed subsequently. The family members with and without sucrase- isomaltase gene mutations were compared in terms of clinical symptoms. The study included 109 cases [mean age ± SD: 22.6 ± 17.2 years (0.1-75 years), 61 males (56%)] of 130 family members of the index case. Sucrase-isomaltase gene c.317G>A (p.C106Y) heterozygous mutation was detected in 27 cases (24.7%); 14 (51.9%) were male and had a mean age of 23.2 ± 18.3 years. The most common complaints of 12 (44.4%) symptomatic patients with mutations were abdominal pain (37%), gas irritability (33.3%), bloating (22.2%), and foul-smelling stools (18.5%). Compared with the cases without mutation, a statistically significant difference was observed in the incidence of gas irritability, foul-smelling stool, ≥2 gastrointestinal symptoms, postprandial complaints, and food allergy (P = .005, P = .047, P = .049, P = .017, P = .021, respectively). Sacrosidase enzyme replacement was applied to 7 patients whose symptoms did not improve with dietary elimination. Clinical response was obtained after enzyme treatment. Despite its autosomal recessive inheritance, congenital sucrase-isomaltase deficiency can also be symptomatic in heterozygous individuals. Further studies are required to clarify the genotype-phenotype relationship and management of the disease.

Особенности пищевых интолерантностей у больных с синдромом раздраженного кишечника

The aim was to evaluate the activity of intestinal carbohydrases in patients with irritable bowel syndrome (IBS) with symptoms of food intolerance. Material and methods. 126 patients with IBS (83 women and 43 men, median age – 32.0 years (Q1–Q3: 27–38 years)) were examined. The diagnosis of IBS was established on the basis of Roman Criteria IV. A questionnaire was conducted for all patients to identify food intolerances, according to the results of which the patients were divided into three groups: the first – patients with isolated intolerance to foods with a high content of FODMAP; the second – patients with isolated intolerance to milk and dairy products; the third – patients with combined intolerance. To determine the activity of intestinal carbohydrates: lactase, sucrose, maltase and glucoamylase, all patients underwent esophagogastroduodenoscopy with biopsy samples from the duodenum. The activity of carbohydrases was determined by the Dahlquist method in the modification of N.I. Belostotsky. The control group consisted of 30 conditionally healthy people (10 men and 20 women, median age – 33.9 years (Q1–Q3: 24–35)), comparable in age and gender with patients with IBS. The activity of intestinal enzymes in this group was within the reference values. Statistical data processing was carried out using the computer program Statistica 8.0. Results. According to the results of the survey, it was found that out of 126 patients with IBS, 52 (41.3%) patients believed that they had food intolerance to certain foods. Isolated intolerance to foods with a high content of FODMAP was noted by 13 (10.3%) patients, 16 (12.7%) patients believed that they had isolated intolerance to milk and dairy products, and 23 (18.3%) patients indicated combined intolerance. In patients with IBS and isolated intolerance to foods high in FODMAP, the median activity of glucoamylase was 120.0 (68.5–209.2) ng/mg of glucose per 1 mg of tissue per minute (ng/mg × min), maltase – 630.5 (480.7–951.0) ng/mg × min, sucrose – 50.0 (32.8–68.8) ng/mg × min, lactase – 10.5 (5.5–40.5) ng/mg × min. Comparing the activity of carbohydrases with the control group revealed the statistically significant difference (p < 0.05) for each enzyme studied.In the group of patients with IBS and isolated intolerance to milk and dairy products, the median activity of all the intestinal enzymes studied was also lower than that in the control group: the activity of glucoamylase was 107.0 (64.0–174.0) ng/mg × min, maltase – 622.0 (481.5–887.0) ng/mg × min, sucrose – 48.0 (35.5-60.0) ng/mg × min, lactase – 8.0 (3.0–22.5) ng/mg × min. Among patients with IBS and the presence of combined intolerance to foods (with a high content of FODMAP and dairy products), the median activity of all enzymes significantly differed from the control group (p < 0.05). The activity of glucoamylase was 107.5 (57.5–194.2) ng/mg × min, maltase – 627.0 (480.7–911.7) ng/mg × min, sucrose - 47.5(34.8–61.5) ng/mg × min, lactase - 9.0 (4.0–28.8) ng/mg × min. Conclusion. Food intolerance was noted in 52 (41.3%) patients with IBS. Among the patients who noted the presence of all the studied food intolerances (isolated or combined intolerance to milk and dairy products, as well as products with a high content of FODMAP), a significant decrease in the activity of intestinal enzymes (glucoamylase, lactase, sucrose and maltase) was found compared with the control (p < 0.05), which may indicate the presence of they have disaccharidase deficiency

556 - Prevalence of disaccharidase deficiencies in children with gastrointestinal symptoms undergoing esophagogastroduodenoscopy (EGD)

556 - Prevalence of disaccharidase deficiencies in children with gastrointestinal symptoms undergoing esophagogastroduodenoscopy (EGD)

S536 Prevalence of Disaccharidase Deficiencies in Adults With Irritable Bowel Syndrome and Functional Diarrhea: Interim Analysis From a Multicenter, Prospective U.S. Trial

S536 Prevalence of Disaccharidase Deficiencies in Adults With Irritable Bowel Syndrome and Functional Diarrhea: Interim Analysis From a Multicenter, Prospective U.S. Trial

Estimating the prevalence of congenital disaccharidase deficiencies using allele frequencies from gnomAD

Background: There are currently three known congenital disaccharidase deficiencies: congenital lactase deficiency (CLD), congenital sucrase-isomaltase deficiency (CSD), and congenital trehalase deficiency (CTD). No congenital deficiency has been described for maltase-glucoamylase (MGAM).Methods: A literature search was performed in PubMed for the pathogenic variants CLD, CSD, and CTD and the articles retrieved were analyzed to estimate the prevalence of congenital disaccharidase deficiencies.Results: Based on reported variants, the estimated prevalence was 1.3 per 106 births (95% CI: 1.1–1.7) for CLD, and 31.4 per 106 births (95% CI: 28.3–34.8) for CSD. Using data on previously reported variants and variants predicted to be loss-of-function in gnomAD, the overall estimated prevalence was 2.3 per 106 births (95% CI: 1.9–2.9) for CLD, 57.6 per 106 births (95% CI:52.5–63.2) for CSD, and 9.2 per 106 births (95% CI: 2.5–3.7) for CTD.Conclusion: The prevalence of CSD was found to be relatively high, while for other congenital disaccharidase deficiencies, the estimated prevalence was very low.

Disaccharidase Deficiency in Pediatric Patients with Inflammatory Bowel Disease

Background: Disaccharidase (DS) deficiencies have been reported in pediatric patients with inflammatory bowel disease (IBD), but the relationship between duodenal inflammation and DS deficiency has not been evaluated outside of lactase deficiency. Methods: This study assessed DS levels and DS deficiencies in pediatric IBD patients who underwent endoscopy with assessment of DS activity. Records were reviewed for IBD subtype, pathology findings, and the results of DS analysis. Results: A total of 136 patients were identified. Overall, 89 (65.4%) patients had a diagnosis of Crohn’s disease (CD), 31 (22.8%) patients had a diagnosis of ulcerative colitis (UC), and 16 (11.8%) patients had a diagnosis of indeterminant colitis. Lactase deficiency was identified in 55.9% of patients, followed by maltase deficiency (19.9%), sucrase and palatinase deficiency (14%), and pan-deficiency (12.5%). When analyzing only patients with CD, patients with duodenitis were more likely to exhibit sucrase deficiency, palatinase deficiency, and pan-deficiency with a trend towards maltase deficiency. Conclusions: The most common DS deficiency was lactase deficiency; however, this was not related to duodenal inflammation. Pediatric patients with CD and duodenal inflammation exhibit DS deficiencies, namely, sucrase, palatinase, and pan-deficiency. Dietary adjustments may be warranted temporarily until duodenal inflammation is healed in patients with CD and duodenitis.

S1376 Yield of Duodenal Biopsy for Disaccharidase Testing in Patients Undergoing Endoscopy for Gastrointestinal Symptoms

Introduction: Disaccharidase deficiencies (DD) often lead to GI symptoms. Recent studies suggest underestimated prevalence of sucrase-isomaltase deficiency (SID) in adults. DD testing often involves small bowel biopsy for disaccharidase activity (maltase, sucrase, palatinase, and lactase). This study aimed to examine the diagnostic yield of disaccharidase testing in patients undergoing endoscopy for GI symptoms. Methods: This case-control study evaluated yield of disaccharidase testing performed Dec 2017 - May 2021 at an academic tertiary-care hospital. Data were extracted via EMR, recording results from disaccharidase testing via a spectrophotometry test (Quest Laboratory), using duodenal biopsy samples. Individual charts were reviewed for data from pre-endoscopy clinic visits, laboratory results, and endoscopy and pathology reports. Data were analyzed after dividing patients into 3 groups: 1. normal disaccharidase testing, 2. isolated lactase deficiency (LD), and 3. Multiple DDs (>1 DD). For categorical variables, Chi-squared testing or Fisher’s exact test and for continuous variables, ANOVA with Tukey’s post-hoc test was used. Results: 387 patients were identified with disaccharidase testing (mean age 47.4 years, 74.7% female, 65.3% Hispanic, mean BMI 26.1 kg/m2). 203 patients (52.5%) had isolated LD and 36 patients (9.3%) had SID (2 DD N = 13, 3 DD N = 15, pan-DD N = 8), with LD accounting for 1 DD in 97.2% of those with >1 DD. African Americans were more likely to have LD compared to non-Hispanic whites (OR = 4.8, P = 0.01). LD Patients were likely to have nausea (OR = 0.51, P = 0.005). No other individual pre-endoscopy symptom was solely predictive of DD. Hgb and iron deficiency anemia were not associated with DD. LD and SID were associated with abnormal duodenal histology (LD: OR = 2.3, P = 0.02; SID: OR = 4.5, P < 0.0001). Among patients with SID, 14 had abnormal duodenal histology and 3 were diagnosed with celiac disease. LD patients were more likely to have H. pylori gastritis (OR = 3.8, P = 0.001). Conclusion: In this large series of 387 patients who underwent disaccharidase testing, LD (52.5%) and SID (9.3%) were common. Underlying GI disorders like celiac disease and peptic injury are contributors to DD, corresponding to the abnormal duodenal histology seen in 14/36 patients with SID. 20 patients had normal duodenal histology, raising the question of possible primary SID. Further adult pan-DD cases are reported. DD may be a primary or comorbid cause of upper GI symptoms, diagnosed via duodenal biopsy.

Patients with functional bowel disorder have disaccharidase deficiency: A single-center study from Russia.

BACKGROUNDFunctional bowel disorder (FBD) may be caused by a decrease in disaccharidase activity. Thus, the timely diagnosis of disaccharidase deficiency could lead to a better prognosis in patients with this condition.AIMTo determine the potential value of intestinal disaccharidases glucoamylase, maltase, sucrase, and lactase in understanding the etiology and pathogenesis of FBD.METHODSA total of 82 FBD patients were examined. According to the Rome IV criteria (2016), 23 patients had diarrhea-predominant irritable bowel syndrome (IBS), 33 had functional diarrhea, 10 had constipation-predominant IBS, 4 had functional constipation, and 12 had mixed IBS. The Dahlqvist method was used to measure disaccharidase activity in the brush-border membrane of mature enterocytes of the small intestine, in duodenal biopsies obtained during esophagogastroduodenoscopy.RESULTSLactase deficiency was detected in 86.5% of patients, maltase deficiency in 48.7%, sucrase deficiency in 50%, and glucoamylase deficiency in 84.1%. The activities of all enzymes were reduced in 31.7% of patients, and carbohydrase deficiency was detected in 63.5% of patients. The low activity of enzymes involved in membrane digestion in the small intestine was found in 95.2% of patients.CONCLUSIONIn 78 of the 82 patients with FBD, gastrointestinal symptoms were associated with disaccharidase deficiency.

Relationships between disaccharidase deficiencies, duodenal inflammation and symptom profile in children with abdominal pain

Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and without histologic duodenitis. Lastly, relationships between individual gastrointestinal symptoms or symptom complexes were evaluated. Lactase deficiency was found in 34.3% of patients and disaccharidase pan-deficiency in 7.6%. No individual symptoms or symptom complexes predicted disaccharidase deficiency. While duodenitis was not associated with disaccharidase deficiency, it was only present in 5.9% of patients. Disaccharidase deficiency, particularly lactase deficiency, is common in youth with abdominal pain and multiple deficiencies are not uncommon. Disaccharidase deficiency cannot be predicted by symptoms in this population. Further studies are needed to assess the clinical significance of disaccharidase deficiency.

Активность дисахаридаз в норме и у пациентов с функциональными заболеваниями кишечника

Objective of the Review: To demonstrate the role of changes in disaccharidase activity in aetiology and pathogenesis of functional enteropathies (FEP). Key Points. In mid-20th century, Russian scientists found out that jejunum diseases can be caused by impaired membrane digestion (MD). Not it is known that irritable bowel syndrome and other FEPs can mask enteropathies with impaired MD. Conclusion. Measurements of disaccharidase activity in duodenum mucosa are a method of choice in diagnosing enteropathies with impaired MD. The information on disaccharidase activity in ileum have not been described in any references. It is assumed that disaccharidase measurements in distal jejunum can be of extra diagnostic significance in examination of patients with FEP. Available information will make it possible to propose an up-to-date concept of aetiology, pathogenesis, clinical course, diagnosis and management of disaccharidase deficiency. Keywords: irritable bowel syndrome, disaccharidases, membrane digestion, A. M. Ugolev, Dahlquist method, FODMAP diet, Rebamipide, probiotics.

Prevalence of Disaccharidase Deficiency in Adults With Unexplained Gastrointestinal Symptoms.

Background/AimsDisaccharidase assay is used for assessing carbohydrate intolerance in children, but its usefulness in adults is not known. The aim of this study is to assess the prevalence of disaccharidase deficiency in patients with unexplained gastrointestinal symptoms.MethodsA retrospective review of adults with chronic (> 1 year) abdominal symptoms and negative imaging and endoscopy/colonoscopy and who completed bowel symptom questionnaire and duodenal biopsy for lactase, maltase, sucrase, and palatinase was performed. A subset also underwent 25 g lactose breath test (LBT).ResultsOne hundred twenty patients (females = 83) were evaluated, of whom 48 also underwent LBT. Fifty-six (46.7%) patients had enzyme deficiency; 44 (36.7%) had single (either lactase or maltase), 1 had 3 enzyme deficiencies, 11 (9.2 %) had all 4 disaccharidase enzyme (pan-disaccharidase) deficiency, and 64 (53.0%) had normal enzyme levels. Baseline prevalence and severity of 11 gastrointestinal symptoms were similar between normal and single enzyme deficiency groups. The sensitivity and specificity of LBT was 78.3% and 72.0%, respectively and overall agreement with lactase deficiency was 75.0%.ConclusionsIsolated disaccharidase deficiency occurs in adults, usually lactase and rarely maltase, and pan-disaccharidase deficiency is rare. Baseline symptoms or its severity did not predict enzyme deficiency.

Stool Reducing Sugars and Stool pH Are Poor Screening Tests for Intestinal Disaccharidase Deficiencies in Children

Tests for stool reducing sugars and stool pH are ordered for children with osmotic diarrhea to screen for carbohydrate malabsorption. We compared the results of the two screening tests, stool reducing sugars and stool pH, with a more definitive result from an intestinal tissue disaccharidase activity assay ordered for pediatric patients (<18 years old). Overall, 159 patients had results for tissue disaccharidase and stool reducing sugars, but only 115 had additional results of stool pH. Forty-six of the 159 patients had mild, moderate, or severe disaccharidase deficiencies. The sensitivity and specificity of the screening tests were calculated for individual disaccharidase deficiencies. In addition, trends of abnormal tissue disaccharidase, stool reducing sugars, and stool pH results were examined in different age groups. The sensitivities for stool reducing sugars and stool pH were 9% to 28% and specificities were 74% to 81% for individual disaccharidase deficiencies. Infants (0 years of age) had the highest percentage of abnormal results across all three tests; however, the positive predicative values were 54% and 50% for stool reducing sugars and stool pH, respectively. The screening tests, stool reducing sugars and stool pH, had low sensitivity compared with results of measured tissue disaccharidase activity in pediatric patients. Infants had the highest percentage of abnormal results for all three tests, but the screening tests still performed poorly in that age group. This study suggests that stool reducing sugars and stool pH should not be used as screening tests for carbohydrate malabsorption due to disaccharidase deficiencies in pediatric patients.

555 Disaccharidase Dilemma in Adults: Utility of Routine Assays in Diagnostic Upper Endoscopies

INTRODUCTION: Disaccharidase assay for evaluating abdominal pain has been well studied in the pediatric population. Deficiency of lactase or sucrase-isomaltase can present with chronic diarrhea, flatulence, abdominal pain, and bloating in such patients. However, the prevalence of disaccharidase deficiencies in adult populations with such symptoms has not been well delineated. METHODS: Distal duodenal specimens from 100 patients with above symptoms, who underwent an upper endoscopy (EGD) at an outpatient facility were submitted for disaccharidase assay. Standardized laboratory cut off values were used to determine disaccharidase levels that were outside the normal range. Statistical analysis was done to determine the frequencies of abnormal disaccharidases. Analysis of the group, with normal or low lactase/sucrase and presenting clinical features, was performed. RESULTS: Mean age of study patients was 52 years and 46% of the patients were male. The racial distribution was as follows: 45% White, 23% Hispanic, 18% Asian, 6% Black, 8% other. Table 1 shows the frequencies of normal and low values for these patients. 84% of the cohort had low lactase, 21% had low sucrase, and 11% had all 4 values in normal range. Figure 2 shows the distribution of the remaining patients who had at least 1 abnormal disaccharide. CONCLUSION: The association between abdominal symptoms and carbohydrate malabsorption in adults is widely recognized, but testing is rarely performed by gastroenterologists in clinical practice. Dietary recommendations are often made empirically. We investigated the prevalence of low disaccharidase levels in the adult population with above symptoms. Besides lactase deficiency, a significant number of patients also had deficiency of sucrase, maltase and palatinase. While this study cannot establish a causal relationship between low levels noted and patient symptoms, this information can be used to recommend appropriate diets or the use of lactase and sucrase enzyme supplements offering a more selective approach in patient care.

Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome.

Patients with irritable bowel syndrome (IBS) frequently have meal-related symptoms and can recognize specific trigger foods. Lactose intolerance is a well-established carbohydrate malabsorption syndrome that causes symptoms similar to IBS such as bloating, abdominal pain, and diarrhea. However, the prevalence of sucrase-isomaltase deficiency (SID) in this population is poorly defined. SID is a condition in which sucrase-isomaltase, an enzyme produced by brush border of small intestine to metabolize sucrose, is deficient. Just like lactase deficiency, SID causes symptoms of maldigestion syndromes including abdominal pain, bloating, gas, and diarrhea. In this study, we aim to determine the prevalence of SID in patients with presumed IBS-D/M and characterize its clinical presentation. Patients with a presumed diagnosis of IBS-D/M based on symptoms of abdominal pain, diarrhea, and/or bloating who underwent esophagogastroduodenoscopy with duodenal biopsies and testing for disaccharidase deficiency were included. Patients with a history of inflammatory bowel disease, gastrointestinal malignancy, or celiac disease were excluded. Odds ratio was calculated for abdominal pain, diarrhea, and bloating in patients with versus without SID. A total of 31 patients with clinical suspicion for IBS-D/M were included with a median age of 46years (IQR 30.5-60) and with 61% females. SID was present in 35% of patients. Among patients with SID, 63.6% had diarrhea, 45.4% had abdominal pain, and 36.4% had bloating. Patients with SID were less likely than controls to have abdominal pain (OR 0.16, 95% CI 0.03-0.81, p = 0.04) although no difference in diarrhea or bloating was found. Only two patients with SID underwent sucrose breath testing of which only one had a positive result. However, this patient also had a positive glucose breath test and may have had small intestinal bacterial overgrowth as a confounder. SID was found in 35% of patients with presumed IBS-D/M and should be considered in the differential diagnosis of patients presenting with abdominal pain, diarrhea, or bloating. Further studies should better characterize the clinical features of SID and investigate the effects of dietary modification in this group of patients.

The relationship between disaccharidase deficiencies and irritable bowel syndrome in childre - A literature review

The relationship between disaccharidase deficiencies and irritable bowel syndrome in childre - A literature review

Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.

Дисахаридазная недостаточность у больных целиакией в период гистологической ремиссии

Дисахаридазная недостаточность у больных целиакией в период гистологической ремиссии

Tu1288 – The Prevalence of Disaccharidase Deficiency in Children and Young Adults with Eosinophilic Esophagitis

Tu1288 – The Prevalence of Disaccharidase Deficiency in Children and Young Adults with Eosinophilic Esophagitis