Congenital sucrase-isomaltase deficiency: diagnostic challenges and response to enzyme replacement therapy

Arch Dis Child. 2015 Sep;100(9):869-71. doi: 10.1136/archdischild-2015-308388. Epub 2015 Jul 10.


Congenital sucrase-isomaltase (SI) deficiency is a rare genetic condition characterised by a deficiency in the brush-border SI enzyme, resulting in an inability to metabolise sucrose and starches. Six cases of congenital SI deficiency treated with Sucraid (sacrosidase, a yeast-derived enzyme that facilitates sucrose digestion) are described. Typical presenting symptoms were watery diarrhoea, abdominal pain and bloating, sometimes noticeably worse after ingestion of fruit. Diagnosis is challenging since conventional hydrogen breath testing after an oral sucrose load is impractical in young children, and many laboratories no longer look for maldigested sucrose using faecal sugar chromatography. Confirmation is by disaccharidase assay of duodenal or jejunal mucosa obtained endoscopically. All six patients showed little improvement following advice regarding dietary management, but experienced a marked reduction in symptoms with sacrosidase administration; no adverse events were reported. Sacrosidase is an effective and well-tolerated treatment for patients with congenital SI deficiency. Gene testing and clinical trial of sacrosidase may become an alternative to endoscopic biopsies for diagnosis.

Keywords: Gastroenterology; Growth; Infant Feeding; Metabolic; Paediatric Practice.

MeSH terms

  • Carbohydrate Metabolism, Inborn Errors / complications
  • Carbohydrate Metabolism, Inborn Errors / diagnosis*
  • Carbohydrate Metabolism, Inborn Errors / drug therapy*
  • Child, Preschool
  • Diarrhea / etiology
  • Diarrhea, Infantile / etiology
  • Enzyme Replacement Therapy / methods*
  • Feces / chemistry
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Sucrase-Isomaltase Complex / deficiency*
  • Sucrose / analysis
  • Treatment Outcome
  • beta-Fructofuranosidase / therapeutic use*


  • Sucrose
  • Sucrase-Isomaltase Complex
  • beta-Fructofuranosidase

Supplementary concepts

  • Sucrase-isomaltase deficiency, congenital