Lactose intolerance-a confusing clinical diagnosis.
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Adolescent↗
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[High lactose content of the Lundh test meal adversely affects the reliability of the ALTAB test].
UNLABELLED: The exocrine pancreatic function was examined in 20 patient without any detectable gastrointestinal disorder. We used 1 g 4(N-acetyl-L-thyrosil) aminobenzoic acid (ALTAB) an Lundh's test meal containing 25 g lactose, and the test was repeated with 3 g lactase (Galantase). The urine was collected for 6 hours to check PABA excretion in urine. Lactose intolerance was diagnosed in 10 patients on the basis of an increase of H2 in the breath at least 15 ppm after Lundh's test meal and/or diarrhoea after test in two hours if this diarrhoea could be prevented by giving Galantase orally. We measured PABA excretion in patients with and without lactose intolerance after Lundh's test meal: 17.8% (SD = 6.7) and 47% (SD = 13) respectively (p less than 0.001), and after Lundh's test meal with Galantase: 34.3% (SD = 12.7) and 43.6% (SD = 10.9) respectively. The increase after Galantase in the group with lactose intolerance was significant (p less than 0.01). CONCLUSIONS: 1. Lactose content of Lundh's test meal causes a considerable lactose load in patients with lactose intolerance. 2. Oral lactase enzyme usually normalises the result of ALTAB test. 3. It is necessary to detect lactose intolerance before use of Lundh's test meal.
4-Aminobenzoic Acid↗
Improved accuracy of lactose tolerance test in children, using expired H2 measurement.
Expired hydrogen and blood glucose were measured during an oral lactose tolerance test in 163 children aged between 9 months and 14 years. Lactose malabsorption, defined as an abnormal increase in expired H2 during a lactose tolerance test, was found in 54 children. Of these, 30 were found to be lactose intolerant as the increased expired H2 was accompanied by clinical symptoms. The other 109 children, in whom there was no rise in expired H2, were assumed to have normal lactose absorption. In children with lactose intolerance the increase in expired H2 tended to occur earlier after lactose ingestion than in children with malabsorption. The mean value of the rise in blood glucose was 2.4 mmol/100 ml) in the lactose-tolerant children and 1.0 mmol/1 (18 mg/100 ml) in the lactose-intolerant ones. Although this difference is significant (p less than 0.001), the rise in blood glucose, in predicting the correct diagnosis, was wrong in 13% of cases in the lactose-tolerant group, and wrong in 37% in the lactose-intolerant group (95% confidence limits 9-19% and 22-53% respectively). It is concluded that a rise in blood glucose, whether or not of more that 1.2 mmol/1 (22mg/100 ml) is of little help in differentiating lactose tolerance from intolerance.
Adolescent↗
Jejunoscopic lactose provocation.
A new method for testing lactose intolerance was developed. The examination is performed by jejunoscopy using lactose dilution for provocation and sucrose for control. Macroscopic and microscopic changes in the jejunal mucosa are examined after administration of solutions. The results of this study demonstrated that lactose administration causes prompt change in the jejunal mucosa in cases of lactose intolerance but had no effect in cases of lactose tolerance. Administration of sucrose did not result in any change. This method is effective in proving lactose intolerance and may be useful to elucidate the pathogenesis of this disorder.
Adult↗
Incomplete lactose absorption from breast milk during acute gastroenteritis.
The incidence and degree of incomplete lactose absorption was investigated in breast fed infants and children up to two years of age during acute gastroenteritis (GE). Lactose absorption was assessed in 50 patients by means of the hydrogen breath test (HBT), approximately 5.5 days after the admission to hospital. HBT detected incomplete lactose absorption of marked (lactose malabsorption) and probably mild degree in 8 and 6 patients respectively. Incomplete lactose absorption appeared to be transient in all 5 patients retested after discharge. HBT failed to identify 8 cases of lactose intolerance which were detected by investigation of the stools. In 31 breast fed controls of a similar age range incomplete lactose absorption of only mild degree was probably present in 2 and lactose intolerance in 1, which too was only detected by investigation of stools. During acute GE the use of HBT is appropriate to detect milder forms of incomplete lactose absorption than lactose intolerance. For the detection of lactose intolerance the measurement of pH and reducing substances in the stools remains the method of choice. The findings are in favour of the continuation of breast feeding during acute GE.
Acute Disease↗
[Lactose and gluten intolerance: which to suscept?].
Lactose intolerance affects millions of people world-wide and should be suspected specially when evaluating gastrointestinal symptoms in ethnic populations in which it is prevalent. Fortunately, once a diagnosis is made, management is fairly straightforward. The authors discuss symptoms and methods of detection and offer their recommendations for helping patients with this common disorder. Coeliac disease is the end result of 3 processes that culminate in intestinal damage: genetic predisposition, environmental factors, and immunological based inflammation. Epidemiological studies based on serologic tests suggest that the prevalence of coeliac disease has been significantly underestimated. The classic sprue syndrome of steatorrhea and malnutrition may be less common than more subtle and often monosymptomatic presentations of the disease. The authors discuss the diagnostic criteria and the clinical utility of serologic tests.
Barium Sulfate↗
[Gluten intolerance, hypothyroidism, lactose and fructose malabsorption--a new "syndrome"?].
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Celiac Disease↗
Efficacy testing of beta-galactosidase with H2 breath test in patients with carbohydrate malabsorption.
The clinical efficacy and the potential side-effects of beta-galactosidase were studied in adult lactose intolerance. Various randomized oral tolerance tests were performed using lactose solution (35 g), glucose + galactose solution (17.5 + 17.5 g), native, skimmed milk and milk pretreated with beta-galactosidase. In each case, simultaneous examinations were made of the glucose concentration of capillary blood by an instrument constructed by the authors, of the H2 content of expired air as also of the subjective complaints and of the number of stools and their pH. It was established that pretreatment of milk with beta-galactosidase has a beneficial effect in adult lactose maldigestion, since it stops dyspeptic complaints and diarrhoea due to milk, it reduces the H2 content of expired air increases blood glucose concentration. Measuring the H2 content of the breath by using and instrument constructed by the authors, exact data can be obtained noninvasively, and rapidly on the degree of carbohydrate malabsorption in patients with lactose-intolerance.
Adult↗
[Poor digestion and intolerance to lactose in Mexican adults. Importance of evaluating them with regular doses of milk].
Lactose digestion capacity after ingestion of habitual doses of milk and its effect on milk intolerance and consumption were studied in 205 mexican adults. In a double-blind study, subjects received two treatments involving the intake of 360 mL of intact whole milk and the same amount of 90% lactose-hydrolyzed milk. Lactose maldigestion was determined by the hydrogen breath analysis test and was detected in 31.5% of the subjects. Symptoms of milk intolerance were present in only 9.5% of the study population. The prevalence lactose maldigestion and intolerance in mexican adults is lower than previous values reported using pharmacological doses of lactose. No effect of lactose intolerance on habitual consumption of milk was detected.
Adolescent↗
Lactose malabsorption in Israeli children.
Lactose malabsorption during childhood was studied in 110 Jewish children in Israel, using the lactose hydrogen breath test. Sixty-eight subjects (61.8%) were lactose malabsorbers, 41 (60.3%) of whom were lactose-intolerant with symptoms evidenced during or following the tests, whereas 27 (39.7%) were symptom-free (tolerant malabsorbers). In the youngest age-group (4 months to 3 years), no lactose malabsorption was detected, whereas in the higher age-groups the prevalence of lactose malabsorption increased with age. The percentages of lactose malabsorption in the age-groups 3 to 6, 6 to 12 and 12 to 16 years were 56.5, 65.2 and 75.0%, respectively. The percentages of lactose-intolerant subjects also increased in the same age-group, to 26.5, 39.1 and 65.0%. There were no significant differences in lactose malabsorption and tolerance between the various ethnic groups tested. The peak values of breath hydrogen were higher in lactose-intolerant than in lactose-tolerant malabsorbers.
Adolescent↗
[Breath hydrogen test to evaluate lactose absorption and small bowel bacterial overgrowth in children].
The aim of this study was to determine the lactose absorption capacity and possible existence of bacterial overgrowth in the small bowel in asymptomatic school children of low social economic level in Marilia, a city located in the interior of São Paulo state. Eighty three children aging 7 to 15 years old without any gastrointestinal manifestations at least 30 days prior to the tests were studied. All the patients had fasted for at least 8 hours before the tests were performed. Lactose absorption was evaluated by breath hidrogen test after an overload of lactose 18 g in 10% aquous solution. Lactose intolerance was determined by the occurrence of clinical symptoms, such as diarrhea, abdominal pain, flatulence, etc in the following 24 hours after the test was performed. Bacterial overgrowth was evaluated by the breath hidrogen test after a 10 g lactulose load in aqueous solution. Lactose malabsorption was detected in 19 (22.9%) children and lactose intolerance was observed in 10 (12%) children. Lactose intolerance was more frequently observed in children who showed lactose malabsorption (6/19; 31.6%) than in those who presented a normal test (4/64; 6.3%) (P = 0.008). Bacterial overgrowth was detected in six (7.2%) children and showed no statistical relationship with lactose malabsorption. Ontogenetic lactose malabsorption verified in this group of school children is similar to the reported for Caucasian populations. Presence of bacterial overgrowth confirms the existence of asymptomatic environmental enteropathy in children of low social economic level.
Adolescent↗
All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial.
OBJECTIVE: To compare the efficacy of three commercially available oral lactase preparations in adults with lactose intolerance. METHODS: Design--Prospective, randomized, placebo-controlled trial. Setting--Outpatient study in a General Clinical Research Center. Subjects--Ten lactose-intolerant healthy volunteers were challenged with ice cream containing 18 g of lactose. Lactase or placebo was given immediately prior to challenge. Measurements--Symptoms and breath hydrogen excretion were recorded for 3 h following lactose challenge. RESULTS: The three products differed in their abilities to influence symptoms and breath hydrogen excretion. Only Lactaid reduced the breath hydrogen excretion with lactose (mean peak, area under the curve and cumulative breath hydrogen excretion) (p < 0.05). Lactrase and Dairy Ease influenced symptoms: Lactrase reduced pain, bloating and total symptomatic scores (p < 0.05), whereas Dairy Ease only reduced pain (p < 0.05). Lactaid administration did not reduce symptoms. CONCLUSION: In lactose-intolerant subjects, the available lactase preparations differ in their ability to improve both breath hydrogen excretion and symptoms. Lactrase may be the product of choice for achieving symptomatic improvement.
Adult↗
Wide variations in the testing of lactose tolerance: results of a questionnaire study in Finnish health care centres.
About 70% of the world's adult population is unable to digest lactose, the sugar found naturally only in milk. This disability leads to gastrointestinal symptoms called lactose intolerance. In Finland, many patients visit health care centres because they are suffering from gastrointestinal symptoms. A few of them are diagnosed as being lactose intolerant. However, a far larger number diagnose themselves as suffering from lactose intolerance. Therefore the diagnostic tests used should be carefully validated and standardized in clinical laboratories throughout the country. The aim of this questionnaire study was to clarify the situation centres with adult patients in Finnish health care and to try to standardize procedures for administering lactose tolerance tests.
Adult↗
Lactose and milk intolerance: clinical implications.
We studied 166 hospitalized male patients to determine the clinical importance of tolerance-test-determined "lactose intolerance," assumed to affect most of the world's adults. Abnormal lactose tolerance tests were found in 81% of 98 blacks, 12% of 59 whites of Scandinavian or Northwestern European extraction, and three of nine non-European whites. Seventy-two per cent of the "lactose-intolerant" subjects had previously realized that milk drinking could induce abdominal and bowel symptoms. Two hundred and forty milliliters of low-fat milk produced gaseousness or cramps in 59% of 44 "lactose-intolerant" men, and 68% were symptomatic with the equivalent amount of lactose. None of 18 "lactose-tolerant" men noted symptoms with milk or lactose. Refusal to drink 240 ml of low-fat milk served with meals correlated significantly with "lactose-intolerance": 31.4% versus 12.9% among "lactose-tolerant" patients. "Lactose intolerance" is common in adults and is a clinically relevant problem.
Adult↗
Infantile colic. Association with lactose and milk intolerance.
Intolerance to lactose and cow's milk protein was prospectively evaluated in 56 infants with apparent colic. A complete blood cell count, sedimentation rate, test for quantitative IgE level, radioallergosorbent test (performed in 15 patients), and at least three stool examinations for pH, presence of reducing substances, and occult blood were performed in 56 infants (46, appropriate size for gestational age; ten, small for gestational age) and results were within normal limits for age. This study suggests that tolerance to lactose and cow's milk protein does not have a significant role in infantile colic.
Animals↗
Milk lactose malabsorption in Gabon measured by the breath hydrogen test.
It is usual to consider that the greatest part of the black African population is lactose intolerant. Also, milk lactose malabsorption was studied by a breath hydrogen technique in 87 Gabonese children and 20 Gabonese adults (central Africa). The prevalence of malabsorption was 64.2% in rural schoolchildren, 65% in the urban hospitalized, and 60% in adults. Twelve children and six adults had clinical symptoms after a lactose load. All subjects were Bantus, with no tradition of consuming dairy products. These data must be considered in programs of nutritional support in Africa.
Adolescent↗
Lactose handling by women with lactose malabsorption is improved during pregnancy.
OBJECTIVE: To evaluate lactose handling among women in late pregnancy and post partum to determine whether lactose handling is altered in pregnancy. DESIGN: Prospective study of lactose intolerance among pregnant women with and without lactose malabsorption. SETTING: Gastroenterology service of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal. PATIENTS: Thirty-three pregnant women, of whom 18 had lactose malabsorption, 12 did not and 3 were excluded. OUTCOME MEASURES: Lactose breath hydrogen (BH2) concentration after ingestion of lactose or lactulose; comparison before and after delivery of area under the curve (AUC) for lactose, oral-cecal transit time (OCTT) for lactulose, lactose-BH2-derived transit time and estimated dietary lactose consumption. RESULTS: After weaning (at a median time of 9 months after delivery), 28 of the women returned for follow-up. Of the 12 who could absorb lactose before delivery, 4 could no longer absorb lactose. Of the other 16 women, lactose intolerance worsened in 12, remained the same in 2 and improved in 2. The AUC was greater (p < 0.005), the maximal BH2 concentration was higher (p = 0.004) and the number of women whose BH2 concentration peaked was fewer (p < 0.025) post partum than before delivery. The women's symptoms during and after lactose BH2 tests were also greater post partum. The OCTT (based on the lactulose BH2 test) was shorter post partum (p = 0.001). Transit time derived from lactose BH2 tests was also shorter, but not significantly so. The OCTT was not inversely correlated with the change in AUC before and after delivery, but the lactose-BH2-derived transit time was inversely correlated. Pregnant women consumed more lactose before delivery than afterward (p < 0.004). CONCLUSIONS: Women with lactose malabsorption handle lactose better than usual in late pregnancy. Slow intestinal transit and bacterial adaptation to increased lactose intake may be primarily responsible.
Breath Tests↗
Milk drinking by the elderly of three races.
The three objectives of this study were to determine: (a) If milk was acceptable for multi-racial groups of elderly people, some of whom had previously been described as lactose intolerant, (b) the frequency of milk rejection attributed to symptoms of lactose intolerance, and (c) the importance of offering different types of milk. The study was carried out on 347 elderly citizens participating in the Title VII Nutrition Program for the Elderly in Harris County, Texas. Eighty-five per cent of the Mexican-Americans, 93.5 per cent of the blacks, and 94 per cent of the Anglos surveyed reported drinking the milk served with their meal. Only 6.6 per cent of the Mexican-Americans, 1.4 per cent of the blacks, and 2.5 per cent of the Anglos did not consume the milk because of symptoms that might be related to low levels of intestinal lactase. It was concluded that milk could and should be served to multi-racial groups of elderly people. Offering a choice of milk type appeared to be important for acceptance. Twenty-two per cent of the blacks, 4 per cent of the Mexican-Americans, and 16 per cent of the Anglos always preferred buttermilk.
Black or African American↗