Glucose-Galactose Malabsorption

Glucose-Galactose Malabsorption

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Glucose-Galactose Malabsorption is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Carbohydrate Intolerance of Glucose Galactose
  • Complex Carbohydrate Intolerance
  • Monosaccharide Malabsorption

Disorder Subdivisions

  • None

General Discussion

Glucose-galactose malabsorption is an inherited metabolic disorder characterized by the small intestine's inability to transport and absorb glucose and galactose (simple sugars or monosaccharides). Glucose and galactose have very similar chemical structures, and normally the same transport enzyme provides them with entry into specialized cells in the small intestine where they are absorbed and transferred to other cells. As a result of a mutation on chromosome 22, the transport enzyme does not function properly and the result is glucose-galactose malabsorption.

Symptoms

Symptoms may begin as early as the first day of life or a few days after birth, when the newborn is exposed to lactose from milk. They include severe, chronic diarrhea, dehydration, and failure to thrive. Early recognition and treatment are important. In severe cases, the disorder may become life-threatening.



Among infants, discontinuation of oral feeding may stop the diarrhea but it will start again when oral feeding is reinstated if the child is fed formula containing glucose. The diarrhea can be quite severe and may readily lead to nutritional wasting and severe dehydration.



In some cases, the affected child grows up with chronic but intermittent diarrhea made worse by sugar-rich meals. Modest amounts of sugar in the urine (glucosuria) of an affected child may be a warning that kidney stones are developing.



In adults, symptoms of glucose-galactose malabsorption may include bloating, nausea, diarrhea, abdominal cramps, rumbling sounds caused by gas in the intestine (borborygmi) and excessive urination.

Causes

Glucose-galactose malabsorption (GGM) is inherited as an autosomal recessive trait. The malfunctioning (mutated) gene codes for (initiates the manufacture of) a protein that acts as a transporter of glucose and galactose out of the space enclosed by the small intestine (called the lumen) across the intestinal lining and into intestinal cells.



As a result of a mutation that has been tracked to a gene on the long arm of chromosome 22 (22q13.1), the transporter enzyme cannot do its job properly. There is nowhere for the glucose and galactose to go except into the stools in rather large amounts. Left untransported, these nutrients draw large amounts of water out of the body into the intestinal lumen, leading to an acute diarrhea known as osmotic diarrhea. The gene associated with this disorder is known as SGLT1.



Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated "p" and a long arm designated "q". Chromosomes are further sub-divided into many bands that are numbered. For example, "chromosome 22q13.1" refers to band 13.1 on the long arm of chromosome 22. The numbered bands specify the location of the thousands of genes that are present on each chromosome.



Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.



Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%. The risk is the same for males and females.



All individuals carry a few abnormal genes. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.

Affected Populations

Glucose-galactose malabsorption is an extremely rare disorder. It's been estimated that there are approximately 200 cases worldwide. Two-thirds of those affected are females. One report suggests that about half of the cases of severe GGM reported have occurred among families that have experienced intermarriage (consanguinity).

Standard Therapies

Diagnosis

The diagnosis is usually made upon review of the presenting signs especially the pervasive, watery diarrhea. A simple test, known as the "glucose breath hydrogen test" is often used to confirm the physical diagnosis.



Treatment

Treatment of glucose-galactose malabsorption requires the elimination of all milk and milk products from the diet since milk products contain lactose and lactose is broken down to glucose and galactose. Fructose, a sugar absorbed differently from either glucose or galactose, may be substituted as a source of carbohydrate calories. Most clinicians who treat this disorder recommend the elimination of all lactose, sucrose and glucose from the diet. These sugars may be replaced by fructose-based nutrients.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.



For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Prizont R. Glucose-Galactose Malabsorption. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:343.



Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:298-99.



Wright EM, Martin MG, Turk E. Familial Glucose-Galactose Malabsorption and Hereditary Renal Glycosuria. In: Scriver CR, Beaudet AL, Sly WS, et al. Eds. The Metabolic Molecular Basis of Inherited Disease. 8th ed. McGraw-Hill Companies. New York, NY; 2001:4895-904.



JOURNAL ARTICLES

Stelzner M, Chen DC. To make a new intestinal mucosa. Rejuvenation Res.2006;9:20-25.



Scheepers A, Joost HG, Schurmann A. The glucose transporter families SGLT and GLUT: molecular basis of normal and aberrant function. JPEN J Parenter Enteral Nutr. 2004;28:364-71.



Tasic V, Slaveska N, Blau N, Santer R. Nephrolithiasis in a child with glucose-galactose malabsorption. Pediatr Nephrol. 2004;19:244-46.



Wright Em, Martin MG, Turk E. Intestinal absorption in health and disease - sugars. Best Pract Res Clin Gastroenterol. 2003;17:943-56.



Wright EM, Turk E, Martin MG. Molecular basis for glucose-galactose malabsorption. Cell Biochem Biophys. 2002;36:115-21.



FROM THE INTERNET

Glucose Galactose Malabsorption. Genes and Disease. NCBI. nd. 2pp.

www.ncbi.nlm.nih.gov/disease/ggm.html



McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Glucose/Galactose Malabsorption; GGM. Entry Number; 606824: Last Edit Date; 4/15/2002.

Resources

March of Dimes Birth Defects Foundation

1275 Mamaroneck Avenue

White Plains, NY 10605

Tel: (914)997-4488

Fax: (914)997-4763

Tel: (888)663-4637

Email: Askus@marchofdimes.com

Internet: http://www.marchofdimes.com



NIH/National Institute of Diabetes, Digestive & Kidney Diseases

Office of Communications & Public Liaison

Bldg 31, Rm 9A06

31 Center Drive, MSC 2560

Bethesda, MD 20892-2560

Tel: (301)496-3583

Email: NDDIC@info.niddk.nih.gov

Internet: http://www2.niddk.nih.gov/



Galactosaemia Support Group

31 Cotysmore Road

Sutton Coldfield

West Midlands, B75 6BJ

United Kingdom

Tel: 01213785143

Email: sue@galactosaemia.org

Internet: http://www.galactosaemia.org/



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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