The Intestinal Microbiome but not Clinical Aspects of Inflammatory Bowel Disease is Impacted by Lactose Malabsorption Compared to Lactose Digestion in Children.

BACKGROUND

Dietary exclusion of lactose from patients with inflammatory bowel disease persist with speculation that deleterious effects are mediated through intestinal microbes.

OBJECTIVE

To compare inflammatory bowel disease characteristics and changes in the intestinal microbiome at diagnosis in children with and without lactose malabsorption.

METHODS

A cross-sectional cohort of children (8-17 years of age) diagnosed with Crohn's disease (n=149 [63%]) or ulcerative colitis (n=86) that had undergone lactose breath hydrogen testing was evaluated. The intestinal microbiome of mucosal luminal aspirates was profiled at the time of diagnosis using 16S rRNA gene amplicon sequencing of the V6 hypervariable region.

RESULTS

Of the 235 children, 61 (26%) had lactose malabsorption. Microbial characterization yielded differences in bacterial differential abundance between children that could and could not absorb lactose that varied by intestinal site and between sub-types of inflammatory bowel disease. There were no differences in the ages (13.2±3.0 years [mean±SD] versus 12.7±3.4 years; p=0.25), sex (p=0.88), extent of disease involvement or severity of disease at presentation (p=0.74) when comparing those that could or could not absorb lactose nor was there a difference in the need for initiation of biological agents (p=0.43) during two years of follow-up.

CONCLUSIONS

Lactose malabsorption does not affect the clinical presentation or outcomes of children with inflammatory bowel disease. However, this study establishes that a single non-absorbed fermentable food product can alter the intestinal microbiome in both a regional and disease specific manner. As we continue to learn more about the pathophysiology of inflammatory bowel disease and the role of the intestinal microbiome in disease onset and progression, it would be of benefit to examine the impact of other potential fermentable nutrients and their products on inflammatory bowel disease outcomes.

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:David Mack reports financial support was provided by Genome Canada. David Mack reports financial support was provided by Ontario Genomics Institute. David Mack reports financial support was provided by Canadian Institutes of Health Research. David Mack reports financial support was provided by University of Ottawa Faculty of Medicine. Alain Stintzi reports financial support was provided by Genome Canada. Alain Stintzi reports financial support was provided by Ontario Genomics Institute. Alain Stintzi reports financial support was provided by Canadian Institutes of Health Research. David Mack reports a relationship with MedBiome Inc that includes: equity or stocks. Alain Stintzi reports a relationship with Medbiome Inc that includes:. David Mack has patent issued to David Mack. Alain Stintzi has patent issued to Alain Stintzi. No other relationships If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.