Skip to main content
PMC home page
Gut logoLink to Gut
. 1996 Sep;39(3):374–381. doi: 10.1136/gut.39.3.374

Evaluation of differential disaccharide excretion in urine for non-invasive investigation of altered intestinal disaccharidase activity caused by alpha-glucosidase inhibition, primary hypolactasia, and coeliac disease.

I Bjarnason 1, R Batt 1, S Catt 1, A Macpherson 1, D Maxton 1, I S Menzies 1
PMCID: PMC1383342  PMID: 8949640

Abstract

BACKGROUND/AIM: The reliability of a quantitative method for the non-invasive assessment of intestinal disaccharide hydrolysis was assessed. METHODS: Differential excretion of intact disaccharide, expressed as ratios of lactulose to appropriate hydrolysable disaccharides in urine collected following combined ingestion, has been investigated in healthy volunteers with drug induced alpha-glucosidase inhibition, in subjects with primary hypolactasia, and patients with coeliac disease. RESULTS: Oral administration of the alpha-glucosidase inhibitor 'Acarbose' (BAY g 5421, 200 mg) together with sucrose and lactulose increased the urinary sucrose/lactulose excretion ratios (% dose/10 h) fivefold. The effect was quantitatively reproducible, a higher dose of 'Acarbose' (500 mg) increasing the excretion ratio to about 1.0 indicating complete inhibition of intestinal sucrase activity. The suitability of the method for measuring differences in dose/response and duration of action was assessed by comparing three different alpha-glucosidase inhibitors (BAY g 5421, BAY m 1099, and BAY o 1248) and found to be satisfactory. Subjects with primary adult hypolactasia had urine lactose/lactulose excretion ratios raised to values indicating reduced rather than complete absence of lactase activity whereas sucrose/lactulose ratios were not significantly affected. 'Whole' intestinal disaccharidase activity assessed by this method demonstrated impairment of lactase, sucrase, and isomaltase in eight, one, and seven, respectively, of 20 patients with coeliac disease. By contrast in vitro assay of jejunal biopsy tissue indicated pan-disaccharidase deficiency in all but five of these patients. This shows the importance of distinguishing between 'local' and 'whole' intestinal performance. CONCLUSIONS: Differential urinary excretion of ingested disaccharides provides a reliable, quantitative, and non-invasive technique for assessing profiles of intestinal disaccharidase activity.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arola H. The strip test for hypolactasia also works without ethanol. Scand J Gastroenterol. 1988 Sep;23(7):851–855. doi: 10.3109/00365528809090772. [DOI] [PubMed] [Google Scholar]
  2. Bedine M. S., Bayless T. M. Intolerance of small amounts of lactose by individuals with low lactase levels. Gastroenterology. 1973 Nov;65(5):735–743. [PubMed] [Google Scholar]
  3. Bjarnason I., MacPherson A., Hollander D. Intestinal permeability: an overview. Gastroenterology. 1995 May;108(5):1566–1581. doi: 10.1016/0016-5085(95)90708-4. [DOI] [PubMed] [Google Scholar]
  4. Bjarnason I., Williams P., So A., Zanelli G. D., Levi A. J., Gumpel J. M., Peters T. J., Ansell B. Intestinal permeability and inflammation in rheumatoid arthritis: effects of non-steroidal anti-inflammatory drugs. Lancet. 1984 Nov 24;2(8413):1171–1174. doi: 10.1016/s0140-6736(84)92739-9. [DOI] [PubMed] [Google Scholar]
  5. Calloway D. H., Murphy E. L., Bauer D. Determination of lactose intolerance by breath analysis. Am J Dig Dis. 1969 Nov;14(11):811–815. doi: 10.1007/BF02235972. [DOI] [PubMed] [Google Scholar]
  6. Grant J. D., Bezerra J. A., Thompson S. H., Lemen R. J., Koldovsky O., Udall J. N., Jr Assessment of lactose absorption by measurement of urinary galactose. Gastroenterology. 1989 Oct;97(4):895–899. doi: 10.1016/0016-5085(89)91494-7. [DOI] [PubMed] [Google Scholar]
  7. Hepner G. W. Breath analysis: gastroenterological applications. Gastroenterology. 1974 Dec;67(6):1250–1256. [PubMed] [Google Scholar]
  8. Hillebrand I., Boehme K., Frank G., Fink H., Berchtold P. The effects of the alpha-glucosidase inhibitor BAY g 5421 (Acarbose) on meal-stimulated elevations of circulating glucose, insulin, and triglyceride levels in man. Res Exp Med (Berl) 1979 Apr 23;175(1):81–86. doi: 10.1007/BF01851236. [DOI] [PubMed] [Google Scholar]
  9. Isokoski M., Jussila J., Sarna S. A simple screening method for lactose malabsorption. Gastroenterology. 1972 Jan;62(1):28–32. [PubMed] [Google Scholar]
  10. Maxton D. G., Catt S. D., Menzies I. S. Combined assessment of intestinal disaccharidases in congenital asucrasia by differential urinary disaccharide excretion. J Clin Pathol. 1990 May;43(5):406–409. doi: 10.1136/jcp.43.5.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Maxton D. G., Catt S. D., Menzies I. S. Intestinal disaccharidases assessed in congenital asucrasia by differential urinary disaccharide excretion. Dig Dis Sci. 1989 Jan;34(1):129–131. doi: 10.1007/BF01536167. [DOI] [PubMed] [Google Scholar]
  12. Menzies I. S., Jenkins A. P., Heduan E., Catt S. D., Segal M. B., Creamer B. The effect of poorly absorbed solute on intestinal absorption. Scand J Gastroenterol. 1990 Dec;25(12):1257–1264. doi: 10.3109/00365529008998562. [DOI] [PubMed] [Google Scholar]
  13. Menzies I. S., Mount J. N., Wheeler M. J. Quantitative estimation of clinically important monosaccharides in plasma by rapid thin layer chromatography. Ann Clin Biochem. 1978 Mar;15(2):65–76. doi: 10.1177/000456327801500116. [DOI] [PubMed] [Google Scholar]
  14. Menzies I. S. Quantitative estimation of sugars in blood and urine by paper chromatography using direct densitometry. J Chromatogr. 1973 Jun 27;81(1):109–127. doi: 10.1016/s0021-9673(01)82322-0. [DOI] [PubMed] [Google Scholar]
  15. Metz G., Jenkins D. J., Peters T. J., Newman A., Blendis L. M. Breath hydrogen as a diagnostic method for hypolactasia. Lancet. 1975 May 24;1(7917):1155–1157. doi: 10.1016/s0140-6736(75)93135-9. [DOI] [PubMed] [Google Scholar]
  16. Müller M., Walker-Smith J., Shmerling D. H., Curtius H. C., Prader A. Lactulose: a gas-liquid chromatography method of determination and evaluation of its use to assess intestinal mucosal damage. Clin Chim Acta. 1969 Apr;24(1):45–49. doi: 10.1016/0009-8981(69)90139-9. [DOI] [PubMed] [Google Scholar]
  17. Newcomer A. D., McGill D. B. Disaccharidase activity in the small intestine: prevalence of lactase deficiency in 100 healthy subjects. Gastroenterology. 1967 Dec;53(6):881–889. [PubMed] [Google Scholar]
  18. Newcomer A. D., McGill D. B. Lactose tolerance tests in adults with normal lactase activity. Gastroenterology. 1966 Mar;50(3):340–346. [PubMed] [Google Scholar]
  19. Newman A. Breath-analysis tests in gastroenterology. Gut. 1974 Apr;15(4):308–323. doi: 10.1136/gut.15.4.308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Noone C., Menzies I. S., Banatvala J. E., Scopes J. W. Intestinal permeability and lactose hydrolysis in human rotaviral gastroenteritis assessed simultaneously by non-invasive differential sugar permeation. Eur J Clin Invest. 1986 Jun;16(3):217–225. doi: 10.1111/j.1365-2362.1986.tb01332.x. [DOI] [PubMed] [Google Scholar]
  21. Peters T. J., Batt R. M., Heath J. R., Tilleray J. The micro-assay of intestinal disaccharidases. Biochem Med. 1976 Apr;15(2):145–148. doi: 10.1016/0006-2944(76)90041-7. [DOI] [PubMed] [Google Scholar]
  22. Slavin G., Sowter C., Robertson K., McDermott S., Paton K. Measurement in jejunal biopsies by computer-aided microscopy. J Clin Pathol. 1980 Mar;33(3):254–261. doi: 10.1136/jcp.33.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Stewart J. S., Pollock D. J., Hoffbrand A. V., Mollin D. L., Booth C. C. A study of proximal and distal intestinal structure and absorptive function in idiopathic steatorrhoea. Q J Med. 1967 Jul;36(143):425–444. [PubMed] [Google Scholar]
  24. WESER E., SLEISENGER M. H. LACTOSURIA AND LACTASE DEFICIENCY IN ADULT CELIAC DISEASE. Gastroenterology. 1965 May;48:571–578. [PubMed] [Google Scholar]
  25. Walton R. J., Sherif I. T., Noy G. A., Alberti K. G. Improved metabolic profiles in insulin-treated diabetic patients given an alpha-glucosidehydrolase inhibitor. Br Med J. 1979 Jan 27;1(6158):220–221. doi: 10.1136/bmj.1.6158.220. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES