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PubMed1995

Etiology of dyspepsia: four hundred unselected consecutive patients in general practice.

BACKGROUND: Four hundred consecutive unselected patients with dyspepsia in health care centers were investigated. The aim of this study was to assess the frequency of various causes of dyspepsia in primary care and to evaluate the usefulness of the latest definition of functional dyspepsia. METHODS: Upper gastrointestinal endoscopy, upper abdominal ultrasound, a test for lactose intolerance, and basic laboratory screening were performed in every patient. RESULTS: Esophagitis was the cause of symptoms in 15%, symptomatic gastroesophageal reflux without esophagitis in 12%, duodenal ulcer in 9%, gastric ulcer in 4%, erosive duodenitis in 2%, lactose intolerance in 9%, gallstone disease in 2%, and malignancy in 2%. Other more infrequent causes of dyspepsia were giardiasis, celiac disease, erosive gastritis, and chronic pancreatitis. One hundred and thirty-five patients had functional dyspepsia with subgroups of ulcer-like (22%), dysmotility-like (28%), and nonspecific (50%). Irritable bowel syndrome was diagnosed in 37 patients (9%). CONCLUSIONS: The cause of dyspepsia was organic in 45%. Functional disorders, when symptomatic gastroesophageal reflux was included, were diagnosed in 55%. The latest classification of functional dyspepsia is not in accordance with the symptom complex.

Adolescent↗
PubMedDate not supplied

Dairy Foods: Are They Politically Correct?

This article considers the scientific evidence on the prevalence and management of verified lactose intolerance and the growing misperception that dairy foods should be avoided because ethnic populations cannot tolerate them. Healthcare professionals, in particular, must understand why eliminating dairy foods is rarely necessary and is generally undesirable. The genetically programmed ability to digest the milk sugar lactose normally declines throughout childhood in all ethnic groups. Only rarely does lactase nonpersistence result in verifiable lactose intolerance. The intolerance-gastrointestinal symptoms, such as diarrhea, bloating, and abdominal cramping-is easily managed when it occurs and is not a barrier to the consumption of 2 to 3 servings of calcium-rich dairy foods, as encouraged by the Dietary Guidelines for Americans.

Journal Article↗
PubMed1990

[Various problems of small-intestinal pathology in children with food allergy].

Altogether 54 children with food allergy characterized clinically by concomitant lesion of the skin and alimentary tract were examined. The results obtained attest to the involvement into the pathological process of the small intestine, to the combination of cow's milk protein and lactose intolerance as well as to the advisability of correcting intestinal dysbiocenosis in order to reduce the disease progress.

Adolescent↗
PubMed1990

Simultaneous assessment of intestinal permeability and lactose tolerance with orally administered raffinose, lactose and L-arabinose.

1. In order to develop an improved differential sugar absorption test for simultaneously assessing intestinal permeability and lactose intolerance, methods were established for determining raffinose, lactose and L-arabinose in human urine. Using NAD(P)H-coupled enzymatic assays and fluorimetry, each sugar was measurable over a concentration range of approximately 3-300 mumol/l in diluted urine specimens. 2. After an overnight fast, 40 normal volunteers drank an iso-osmotic solution containing raffinose, lactose and L-arabinose. The median 5 h urinary sugar excretion was 0.26% of the ingested raffinose, 0.05% of lactose and 17.5% of L-arabinose. 3. In 143 patients with gastrointestinal disease, excretion of both ingested raffinose and lactose was significantly increased in coeliac disease in relapse or in partial remission and in Crohn's disease, but not in the irritable bowel syndrome, coeliac disease in remission or ulcerative colitis. Excretion of lactose, but not raffinose, was increased in patients with mucosal lactase deficiency, whereas excretion of L-arabinose was reduced in all disease groups except ulcerative colitis. 4. Discrimination between diseases was poor when based on individual sugar recoveries, but improved dramatically when excretion was expressed relative to that of L-arabinose. The raffinose/L-arabinose excretion ratio, an index of intestinal permeability, was greater than 0.08 in 15/15 untreated coeliac patients but less than 0.06 in all normal subjects and in 9/9 lactase-deficient patients, 15/16 recovered coeliac patients, 5/6 patients with ulcerative colitis, 13/16 patients with Crohn's disease and 61/62 patients with irritable bowel syndrome.

Adolescent↗
PubMed1995

[Lactose digestion by milk fermented with Lactobacillus acidophilus and Lactobacillus casei of human origin].

The aim of the present study was to determine whether a fermented milk containing Lactobacillus casei and Lactobacillus acidophilus strains isolated from human subjects (CFM) and developed by CERELA (Centro de referencia para Lactobacilos) is better tolerated than regular milk (RM) by subjects with lactase deficiency (< 1 unidad) and lactose intolerance. We studied the digestion of the lactose present in the two milk preparations which were administered to 18 healthy subjects with lactase deficiency and 12 control subjects. Each subject ingested in random sequence on different days, 480 ml CFM, 480 ml RM and 240 ml CFM and 240 ml RM. Breath hydrogen (H2) test was used to measure lactose absorption and orocecal transit time (OCTT). The peak H2 ppm results after 480 ml of CFM were ingested, reached 19.5 +/- 12.1 ppm. The same reading when 480 ml of RM were ingested was 52.6 +/- 31.9 ppm (p < 0.008). The results also showed that 480 ml of CFM delayed OCTT median 111.0 +/- 6.78 min versus 54.0 +/- 5.09 min of RM (p < 0.001) and reduced the development of symptoms (p < 0.08) such as bloating (p < 0.05), borborygmi (p < 0.025) diarrhea (p < 0.05) and abdominal colics (p < 0.05). In spite of the small number of cases studied, it seems justified to conclude that CERELA fermented milk significantly influences lactose digestion and minor development of symptoms in lactase-deficient subjects and lengthens significantly the orocecal transit time compared with regular milk.

Adult↗
PubMedDate not supplied

[Primary lactose malabsorption in healthy Brazilian adult caucasoid, negroid and mongoloid subjects].

A lactose tolerance test consisting of the administration of 50 g lactose as a 10% aqueous solution was applied to 80 healthy adult individuals from Campinas, SP., Brazil (40 caucasoids, 20 negroids and 20 mongoloids of Japanese ancestry) with no secondary lactase deficiency. Lactose malabsorption was manifested by 45% caucasoids, 85% negroids and 100% mongoloids. The lactose malabsorption as assessed by the lactose loading test was more closely associated with symptoms of lactose intolerance (cramps, meteorism and diarrhea) than with fecal alterations (acid pH, as well as detectable glucose and reducing substances in the feces).

Adult↗
PubMed1979

Lactose malabsorption among Masai children of East Africa.

There is much disagreement about milk and its use in feeding programs both in the United States and internationally. A few authors suggest that milk consumption should not be encouraged in lactose intolerant populations due to adverse symptoms. Others suggest, however, that small or modest quantities of milk can be tolerated and can be nutritionally useful to such groups. Data are presented in this paper that show that 1) the Masai regularly drink considerable quantities of milk without apparent symptoms, 2) milk is an important constituent of the Masai diet, and 3) 62% of 21 Masai examined were malabsorbers of lactose as measured by the lactose tolerance test. This finding of lactose malabsorption in a nomadic cattle raising and milk drinking people is interesting and is contrary to the views often expressed by anthropologists and others. An ability to drink nutritionally useful quantities of milk does not, however, necessarily mean that milk production or imports should be encouraged in the Lesser Developed Countries.

Adolescent↗
PubMed1991

Concordance of indirect methods for the detection of lactose malabsorption in diabetic and nondiabetic subjects.

In order to collect data on (1) the prevalence of lactose malabsorption and (2) the value of indirect diagnostic methods for hypolactasia in diabetics, we compared lactose tolerance tests using serum glucose, serum galactose (after oral ethanol intake) and breath hydrogen excretion as diagnostic cutoff in 144 nondiabetic and 46 diabetic subjects. A good rate of concordance was found for the hydrogen breath test and galactose-dependent lactose tolerance test. The glucose-dependent lactose tolerance test was found to be of satisfactory diagnostic value in nondiabetic subjects and was useless for diagnostic purposes in diabetics. Lactose malabsorption was no more frequent in diabetics than in controls and lactose intolerance was found to be less frequent in the diabetic group. A distinction between hypolactasia and other gastrointestinal disorders in diabetics is possible by ambulatory indirect tests.

Adult↗
PubMed2002

Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children.

UNLABELLED: This study investigated faecal calprotectin concentration, a measure of intestinal inflammation, in infants and children with abdominal pain. Faecal calprotectin was measured by an enzyme-linked immunosorbent assay kit in spot stool samples in 76 infants with typical infantile colic, 7 infants with transient lactose intolerance and 27 healthy infants. All infants were 2-10 wk of age. In addition, 19 children with recurrent abdominal pain (RAP; mean age 11.5 y), 17 with inflammatory bowel disease (IBD; mean age 11.1 y; 10 had Crohn's disease and 7 ulcerative colitis) and 24 healthy children (mean age 5.3 y) were studied. In infants with infantile colic the mean faecal calprotectin concentration was not different from that in healthy infants (278 +/- 105 vs 277 +/- 109 mg kg(-1), p = 0.97) or in infants with transient lactose intolerance (300.3 +/- 124 mg kg(-1), p = 0.60). The calprotectin level was similar in boys and girls and fell significantly with age (p = 0.04). Children with IBD had faecal calprotectin levels (293 +/- 218 mg kg(-1)) much higher than healthy children (40 +/- 28 mg kg(-1), p < 0.0001) and children with RAP without identified organic disease (18 +/- 24 mg kg(-1), p < 0.0001). CONCLUSION: Faecal calprotectin may differentiate between functional abdominal pain and IBD in school-aged children. In young infants high faecal calprotectin levels are normal.

Abdominal Pain↗
PubMed1987

[Use of chickpea (Cicer arietinum L.) in non-dairy formulas. I. Chemical composition and nutritive quality of chickpeas and a comparison with commercial infant formulas].

A study was carried out to determine, in rats, the chemical composition and protein quality determinations: PER, NPR and NPU of chick-pea, milk powder and two different commercial infant formulas for babies with lactose intolerance. The formulas studied were "Casec" (calcium caseinate), "Sobee" (soy flour), "Plenilac" (milk powder) and cooked chick-pea flour, alone or supplemented with methionine and/or tryptophan. The protein and fat contents of "Casec" were 88 and 2%, respectively, while chick-pea, "Sobee" and "Plenilac" exhibited 18.9 and 8%, 22 and 18%, 26 and 28%, respectively. The four products were deficient in sulfur amino acids, with "Sobee" exhibiting the lowest chemical score (57), followed by chick-pea (62), "Casec" (68) and "Plenilac" (82). The chick-pea supplemented with methionine was deficient in valine (C.S. 76). The higher values of PER, NPR and NPU were obtained with the chick-pea supplemented with methionine, and with the "Plenilac" samples, while chick-pea without amino acid supplementation, however, had a protein quality similar to "Casec" and to "Sobee". According to these results, therefore, chick-pea alone or supplemented with methionine can be utilized as a milk substitute in malnourished children with lactose intolerance.

Amino Acids↗
PubMed1979

Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study.

Thirty-eight consecutive children with recurrent abdominal pain underwent lactose tolerance tests; 28 of these were also given sucrose tolerance tests. Abdominal pain and abnormal lactose tolerance tests were noted in 11 of 38, while none of the 28 had an abnormal sucrose tolerance test; however, 1 had abdominal pain. Elimination diet for 4 weeks produced significant or total pain relief in 10 of 11 (lactose free) and 0 of 1 children (sucrose free). Lactose intolerance seems to play a contributory role in recurrent abdominal pain in children, while sucrose intolerance does not.

Abdomen↗
PubMed2004

The influence of milk intake on the lead toxicity to the sensory nervous system in lead workers.

The dietary calcium supplement has been suggested to children and pregnant women for prevention of lead toxicity, because of lead-calcium interaction. Lead workers were supplied free milk in Taiwan; however, part of workers did not drink milk due to lactose intolerance. The goal of this study is to evaluate the effects of milk-intake on the peripheral nervous system in workers with long-term lead exposure. We measured 181 workers' current perception thresholds (CPT) as neurological outcomes. The outcome variables were then correlated to the subject's milk intake, blood lead levels, and index of long-term lead exposure that was calculated by the subject's serial blood lead data in a period of working duration. The potential confounders, including age, gender, body height, smoking and alcohol consumption, were also collected and analyzed in multiple regressions. 23 workers who reported never or rarely drinking milk, which meant that they have suffered from diarrhea or abdomen discomfort after drinking milk since childhood, had higher blood lead parameters but not statistically significant, and higher thresholds in sensory nerve tests, especially, statistically significance on 5 and 250 Hz of hand CPTs, which represent C fiber and A-delta fiber. In multiple regression models with control of potential confounders, significant protective effects of milk intake were found on reducing hand CPTs, but not on foot CPTs. Our study, using measurement of sensory nerve CPTs, revealed that drinking milk (two bottles a day, about 700 g per day) might have an effect to protect lead peripheral neurotoxicity. The detail biochemical mechanisms need further investigations. However, reduction of occupational lead exposure is the essential way to protect lead neuropathy. The authors did not emphasize that offers of milk to workers could be instead of occupational hygiene efforts. Furthermore, lead workers with lactose intolerance might be more susceptible, and need more industrial hygiene interventions.

Adult↗
PubMed1999

[Effect of exogenous lactase on the absorption of lactose and its intolerance symptoms].

The objective of this study was to evaluate the effects of lactase on lactose malabsorption and its intolerance symptoms, as well as the available way to improve lactose absorption. Healthy adults with a history of lactose intolerance were screened by 25 g lactose tolerance test. The individuals with higher H2 expired and/or lactose intolerance symptoms were selected as the subjects. Subjects were challenged twice with "400 ml low fat milk" and "400 ml low fat milk + 9000Fcc lactase" separately in 3 days interval. The breath H2 concentration and intolerance symptoms were tested in 4 hours after the challenge. The results showed that exogenous lactase can significantly decrease the incidence of lactose malabsorption (the abnormal expiration of H2 decreased from 100% to 48.9%) and milk intolerance symptoms(from 51.1% to 13.3%). The results from this study demonstrate that lactose malabsorption and intolerance symptoms are resulted from the reduced enzyme activities of individuals, and the exogenous lactase can improve lactose absorption and intolerance symptoms. Lactose supplementation may be an available way to increase the dairy consumption and promote health of people.

Adolescent↗
PubMed1999

Chronic diarrhoea in infants and young children: causes, clinical features and outcome.

OBJECTIVES: To review the causes, clinical features and outcomes of Malaysian children who had chronic diarrhoea. METHODOLOGY: A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997. RESULTS: Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred. CONCLUSIONS: Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.

Age of Onset↗