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Sucrase-Isomaltase Deficiency: Hiding in Plain Sight?

  • Nutrition and Obesity (O Pickett-Blakely, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Our review focuses on the various presentations, diagnosis, and treatment of sucrose–isomaltase deficiency (SID), previously thought to be limited to the pediatric population with severe malabsorptive symptoms.

Recent findings

Although sucrase–isomaltase deficiency is presumed to be a rare disorder, it is likely under recognized and more prevalent than is currently known. Congenital sucrase–isomaltase deficiency usually manifests early in life, but the phenotype may vary depending on the mutation(s) present.

Summary

SID is characterized by dysfunction of the brush border enzyme, sucrase–isomaltase, with a subsequent inability to successfully digest sucrose and starch. This disorder can be further characterized as either a genetic (genetic/congenital sucrase–isomaltase deficiency) or a secondary condition. Sucrase–isomaltase deficiency can result in various clinical symptoms, ranging from mild bloating/flatulence to severe osmotic diarrhea with malabsorption. SID has been associated with irritable bowel syndrome, and further research is needed to further characterize this relationship.

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References and Recommended Reading

  1. Hunziker W, Spiess M, Semenza G, Lodish HF. The sucrase-isomaltase complex: primary structure, membrane-orientation, and evolution of a stalked, intrinsic brush border protein. Cell. 1986;46(2):227–34.

    Article  CAS  Google Scholar 

  2. Gray GM, Lally BC, Conklin KA. Action of intestinal sucrase-isomaltase and its free monomers on an alpha-limit dextrin. J Biol Chem. 1979;254(13):6038–43.

    Article  CAS  Google Scholar 

  3. Lee BH, Quezada-Calvillo R, Nichols BL Jr, Rose DR, Hamaker BR. Inhibition of maltase-glucoamylase activity to hydrolyze alpha-1,4 linkages by the presence of undigested sucrose. J Pediatric sGastroenterol Nutri. 2012;55(Suppl 2):S45–7.

    Article  Google Scholar 

  4. Lin AH, Hamaker BR, Nichols BL Jr. Direct starch digestion by sucrase-isomaltase and maltase-glucoamylase. J Pediatric Gastroenterol Nutri. 2012;55(Suppl 2):S43–5.

    Article  Google Scholar 

  5. Treem WR. Clinical aspects and treatment of congenital sucrase-isomaltase deficiency. J Pediatric Gastroenterol Nutri. 2012;55(Suppl 2):S7–13.

    Article  Google Scholar 

  6. Sibley E. Carbohydrate digestion and absorption. In: Johnson L, ed. Encyclopedia of Gastroenterology. Elsevier; 2004:275-278.

  7. Treem WR. Congenital sucrase-isomaltase deficiency. J Pediatric Gastroenterol Nutri. 1995;21(1):1–14.

    Article  CAS  Google Scholar 

  8. Naim HY, Heine M, Zimmer KP. Congenital sucrase-isomaltase deficiency: heterogeneity of inheritance, trafficking, and function of an intestinal enzyme complex. J Pediatr Gastroenterol Nutr. 2012;55(Suppl 2):S13–20.

    Article  Google Scholar 

  9. Gericke B, Amiri M, Naim HY. The multiple roles of sucrase-isomaltase in the intestinal physiology. Mole Cellular Pediatrics. 2016;3(1):2.

    Article  Google Scholar 

  10. Alfalah M, Keiser M, Leeb T, Zimmer KP, Naim HY. Compound heterozygous mutations affect protein folding and function in patients with congenital sucrase-isomaltase deficiency. Gastroenterology. 2009;136(3):883–92.

    Article  CAS  Google Scholar 

  11. Ouwendijk J, Moolenaar CE, Peters WJ, Hollenberg CP, Ginsel LA, Fransen JA, et al. Congenital sucrase-isomaltase deficiency. Identification of a glutamine to proline substitution that leads to a transport block of sucrase-isomaltase in a pre-Golgi compartment. J Clin Invest. 1996;97(3):633–41.

  12. Husein DM, Wanes D, Marten LM, Zimmer KP, Naim HY. Heterozygotes are a potential new entity among homozygotes and compound heterozygotes in congenital sucrase-isomaltase deficiency. Nutrients. 2019;11(10).

  13. West LF, Davis MB, Green FR, Lindenbaum RH, Swallow DM. Regional assignment of the gene coding for human sucrase-isomaltase (SI) to chromosome 3q25-26. Ann Human Gene. 1988;52(Pt 1):57–61.

    Article  CAS  Google Scholar 

  14. Uhrich S, Wu Z, Huang JY, Scott CR. Four mutations in the SI gene are responsible for the majority of clinical symptoms of CSID. J Pediatric Gastroenterol Nutri. 2012;55(Suppl 2):S34–5.

    Article  Google Scholar 

  15. Haberman Y, Di Segni A, Loberman-Nachum N, et al. Congenital Sucrase-isomaltase Deficiency: A Novel Compound Heterozygous Mutation Causing Aberrant Protein Localization. J Pediatr Gastroenterol Nutr. 2017;64(5):770–6.

    Article  CAS  Google Scholar 

  16. Henström M, Diekmann L, Bonfiglio F, Hadizadeh F, Kuech EM, von Köckritz-Blickwede M, et al. Functional variants in the sucrase-isomaltase gene associate with increased risk of irritable bowel syndrome. Gut. 2018;67(2):263–70.

  17. Marcadier JL, Boland M, Scott CR, Issa K, Wu Z, McIntyre AD, et al. Congenital sucrase-isomaltase deficiency: identification of a common Inuit founder mutation. Cmaj. 2015;187(2):102–7.

  18. Ritz V, Alfalah M, Zimmer KP, Schmitz J, Jacob R, Naim HY. Congenital sucrase-isomaltase deficiency because of an accumulation of the mutant enzyme in the endoplasmic reticulum. Gastroenterol. 2003;125(6):1678–85.

    Article  CAS  Google Scholar 

  19. Sander P, Alfalah M, Keiser M, Korponay-Szabo I, Kovács JB, Leeb T, et al. Novel mutations in the human sucrase-isomaltase gene (SI) that cause congenital carbohydrate malabsorption. Hum Mutat. 2006;27(1):119.

  20. Gericke B, Amiri M, Scott CR, Naim HY. Molecular pathogenicity of novel sucrase-isomaltase mutations found in congenital sucrase-isomaltase deficiency patients. Biochimica et biophysica acta. 2017;1863(3):817–26.

    Article  CAS  Google Scholar 

  21. Bell RR, Draper HH, Bergan JG. Sucrose, lactose, and glucose tolerance in northern Alaskan Eskimos. Am J Clin Nutri. 1973;26(11):1185–90.

    Article  CAS  Google Scholar 

  22. Ellestad-Sayed JJ, Haworth JC, Hildes JA. Disaccharide malabsorption and dietary patterns in two Canadian Eskimo communities. Am J Clin Nutrit. 1978;31(8):1473–8.

    Article  CAS  Google Scholar 

  23. Peterson ML, Herber R. Intestinal sucrase deficiency. Trans Assoc Am Phys. 1967;80:275–83.

    CAS  PubMed  Google Scholar 

  24. Welsh JD, Poley JR, Bhatia M, Stevenson DE. Intestinal disaccharidase activities in relation to age, race, and mucosal damage. Gastroenterology. 1978;75(5):847–55.

    Article  CAS  Google Scholar 

  25. Gudmand-Hoyer E, Fenger HJ, Kern-Hansen P, Madsen PR. Sucrase deficiency in Greenland. Incidence and genetic aspects. Scandinavian J Gastroenterol. 1987;22(1):24–8.

    Article  CAS  Google Scholar 

  26. Quezada-Calvillo R, Robayo-Torres CC, Ao Z, Hamaker BR, Quaroni A, Brayer GD, et al. Luminal substrate "brake" on mucosal maltase-glucoamylase activity regulates total rate of starch digestion to glucose. J Ped Gastroenterol Nutri. 2007;45(1):32–43.

  27. Ringrose RE, Preiser H, Welsh JD. Sucrase-isomaltase (palatinase) deficiency diagnosed during adulthood. Digestive Dis Sci. 1980;25(5):384–7.

    Article  CAS  Google Scholar 

  28. Muldoon C, Maguire P, Gleeson F. Onset of sucrase-isomaltase deficiency in late adulthood. Am J Gastroenterol. 1999;94(8):2298–9.

    Article  CAS  Google Scholar 

  29. DeJonge AMNK, Hernandez K, Elser H, Opekun AR. Sucrase-isomaltase genetic variant carriers can be symptomatic. Gastroenterology. 2014;146:S705–5.

  30. Skovbjerg H. Immunoelectrophoretic studies on human small intestinal brush border proteins--the longitudinal distribution of peptidases and disaccharidases. Clinica chimica acta; Int J Clin Chem. 1981;112(2):205–12.

    Article  CAS  Google Scholar 

  31. Nichols BL Jr, Adams B, Roach CM, Ma CX, Baker SS. Frequency of sucrase deficiency in mucosal biopsies. J Ped Gastroenterol Nutri. 2012;55(Suppl 2):S28–30.

    Article  Google Scholar 

  32. Robayo-Torres CC, Quezada-Calvillo R, Nichols BL. Disaccharide digestion: clinical and molecular aspects. Clin Gastroenterol Hepatol. 2006;4(3):276–87.

    Article  CAS  Google Scholar 

  33. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775–84.

  34. Deb CMD, Ruiz V, Abomoelak B, Avdella A, Smith H, Cooper D. High carrier frequency of the four most common congenital sucrase-isomaltase deficiency pathogenic variants detected in pediatric cases with symptoms and low sucrase versus controls with normal sucrose. J Pediatric Gastroenterol Nutrition. 2017;65(Suppl 2):S89.

    Google Scholar 

  35. Kilby A, Burgess EA, Wigglesworth S, Walker-Smith JA. Sucrase-isomaltase deficiency. A follow-up report. Arch Dis Childhood. 1978;53(8):677–9.

    Article  CAS  Google Scholar 

  36. Antonowicz I, Lloyd-Still JD, Khaw KT, Shwachman H. Congenital sucrase-isomaltase deficiency. Observations over a period of 6 years. Pediatrics. 1972;49(6):847–53.

    CAS  PubMed  Google Scholar 

  37. Harms HK, Bertele-Harms RM, Bruer-Kleis D. Enzyme-substitution therapy with the yeast Saccharomyces cerevisiae in congenital sucrase-isomaltase deficiency. New England J Med. 1987;316(21):1306–9.

    Article  CAS  Google Scholar 

  38. Treem WR, Ahsan N, Sullivan B, Rossi T, Holmes R, Fitzgerald J, et al. Evaluation of liquid yeast-derived sucrase enzyme replacement in patients with sucrase-isomaltase deficiency. Gastroenterol. 1993;105(4):1061–8.

  39. Gascon S, Neumann NP, Lampen JO. Comparative study of the properties of the purified internal and external invertases from yeast. J Biol Chem. 1968;243(7):1573–7.

    Article  CAS  Google Scholar 

  40. Treem WR, McAdams L, Stanford L, Kastoff G, Justinich C, Hyams J. Sacrosidase therapy for congenital sucrase-isomaltase deficiency. J Ped Gastroenterol Nutri. 1999;28(2):137–42.

    Article  CAS  Google Scholar 

  41. Boney A, Elser HE, Silver HJ. Relationships among Dietary Intakes and Persistent Gastrointestinal Symptoms in Patients Receiving Enzyme Treatment for Genetic Sucrase-Isomaltase Deficiency. J Acad Nutr Diet. 2018;118(3):440–7.

    Article  Google Scholar 

  42. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016.

  43. Kim SB, Calmet FH, Garrido J, Garcia-Buitrago MT, Moshiree B. Sucrase-Isomaltase Deficiency as a Potential Masquerader in Irritable Bowel Syndrome. Dig Dis Sci. 2020;65(2):534–40.

    Article  CAS  Google Scholar 

  44. Simmer S, Chey W, Eswaran S, Ranagan J, Petrucelli S. Is sucrase-isomaltase deficiency an under-recognized cause of IBS-D symptoms? Gastroenterology. 2018;Abstract Submitted.

  45. Garcia-Etxebarria K, Zheng T, Bonfiglio F, Bujanda L, Dlugosz A, Lindberg G, et al. Increased Prevalence of Rare Sucrase-isomaltase Pathogenic Variants in Irritable Bowel Syndrome Patients. Clin Gastroenterol Hepatol. 2018;16(10):1673–6.

  46. Zheng T, Eswaran S, Photenhauer AL, Merchant JL, Chey WD, D'Amato M. Reduced efficacy of low FODMAPs diet in patients with IBS-D carrying sucrase-isomaltase (SI) hypomorphic variants. Gut. 2020;69(2):397–8.

    Article  Google Scholar 

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Correspondence to Shanti Eswaran MD.

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Adrienne Lenhart declares no conflict of interest. Shanti Eswaran reports grants from QOL Medical outside the submitted work. William Chey reports personal fees from QOL Medical outside the submitted work.

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Lenhart, A., Chey, W.D. & Eswaran, S. Sucrase-Isomaltase Deficiency: Hiding in Plain Sight?. Curr Treat Options Gastro 19, 500–508 (2021). https://doi.org/10.1007/s11938-021-00357-8

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