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Interval sampling of breath hydrogen (H2) as an index of lactose malabsorption in lactase-deficient subjects.

Interval sampling of breath hydrogen content was used in lactose malabsorbers: (1) to compare hydrogen responses following increasing oral doses of lactose in milk and aqueous solutions; (2) to determine the reproducibility of interval breath sampling, and (3) to compare carbohydrate malabsorption following ingestion of either regular milk or milk containing Lactobacillus acidophilus. Significant differences in breath hydrogen responses due to increasing amounts of lactose in milk and aqueous solutions were observed. The individual breath hydrogen responses were reproducible using the same lactose dose on different days. There was no significant difference in breath hydrogen responses or symptoms following administration of either regular milk or milk containing Lactobacillus acidophilus. Breath hydrogen sampling at intervals, as performed in these studies, provides a sensitive and reproducible index of lactose malabsorption.

Administration, Oral↗

Hydrogen breath test quantification and clinical correlation of lactose malabsorption in adult irritable bowel syndrome and ulcerative colitis.

Lactose malabsorption was studied, by hydrogen breath test, in 72 adults suffering from irritable bowel syndrome, in 20 ulcerative colitis patients, and in 69 healthy subjects. The minimum dose of lactose required to cause a positive breath test was determined, and the symptoms caused and the resulting hydrogen eliminated quantified. A high incidence of lactose malabsorption was shown at standard doses (up to 50 g) in both the healthy subjects (70%) and the patients (86% and 85%, respectively). In the irritable bowel syndrome and the ulcerative colitis groups, symptoms occurred with a smaller quantity of breath hydrogen, presumably in association with a greater individual sensitivity of the colon to distension. The threshold lactose dose was notably lower in the diseased subjects who registered as evidence a prevalence of malabsorption at a 20-g lactose load. The pathogenetic role of lactose malabsorption in the irritable bowel syndrome is emphasized, as is the importance of the personal lactose tolerance.

Adolescent↗

Lactase deficiency in Singapore-born and Canadian-born Chinese.

Seventy-three of 77 adult Singapore-born Chinese (95%) and 48 of 49 Canadian-born adult Chinese (98%) were demonstrated to be lactase deficient using the lactose breath hydrogen test. The similar prevalence of lactase deficiency in the Singapore- and the Canadian-born Chinese despite a larger estimated amount of daily milk ingestion in the Canadian-born Chinese (430 ml vs 157 ml) supports the concept that lactase deficiency, which is transmitted genetically, does not have an adaptable component related to the quantity of lactose ingested. When the lactose breath hydrogen test performed with a dose of 0.5 g/kg of lactose was compared with the test using a standard dose of 50 g of lactose, there was very little loss of sensitivity. In spite of the presence of lactase deficiency, only 32% of the Singapore subjects and 23% of the Canadian subjects had gastrointestinal symptoms when milk was ingested in the daily diet. Peak breath H2 was higher in females than males, but the difference was more significant in the Canadian cohort.

Adolescent↗

Is the assay of disaccharidase activity in small bowel mucosal biopsy relevant for clinical gastroenterologists?

In a retrospective study, jejunal mucosal disaccharidase and alkaline phosphatase activities have been investigated in 40 controls and patients with proven celiac sprue (n = 26), lactase deficiency (n = 26), osteoporosis or osteomalacia (n = 16), chronic pancreatitis (n = 12), giardiasis (n = 7), or Crohn's disease (n = 7). Apart from a nonselective reduction of mucosal enzyme activities in the sprue syndrome and a selective reduction of lactase activity in the patients with primary lactase deficiency, assays of mucosal disaccharidases revealed only inconstant or slight deviations from the control group and were not of diagnostic significance for any of the above-mentioned disorders. Isolated forms of enzyme deficiencies other than lactase deficiency, such as sucrase-isomaltase or trehalase deficiency were not present among 168 investigations carried out from 1972-1982. It is concluded that assay of small intestinal disaccharidase or alkaline phosphatase activities does not expand the diagnostic impact of morphological examination of small bowel biopsy specimens and modern noninvasive methods for the detection of carbohydrate malabsorption. Thus, the method does not appear a necessary or relevant investigation in routine clinical practice.

Adolescent↗

Blood glucose and plasma insulin responses to fat free milk and low-lactose fat free milk in healthy human volunteers.

The blood glucose and plasma insulin responses to test milk samples were studied in healthy normal volunteers. After an overnight fast the subjects were given 500 ml of either regular fat free milk (approximately 25 g lactose) or 500 ml of a new low-lactose fat free milk (3.75 g lactose and 4.25 g fructose). Blood glucose levels were not significantly altered after either milk sample, but plasma insulin responses were significantly elevated after milk consumption. The response was slightly but not significantly higher after regular fat-free milk than after the low-lactose fat free milk. The results suggest that fat free milk does not exert a fast effect on blood glucose concentration and therefore fat free milk and especially low-lactose fat free milk may prove to be suitable for diabetic diets.

Animals↗

Prevalence of lactose maldigestion. Influence and interaction of age, race, and sex.

Ninety-eight adults ranging from 20 to 89 years in age (52 blacks, 46 whites, 48 males, 50 females) were tested for lactose maldigestion by breath hydrogen analysis after consuming milk containing 16.5 g lactose (360 ml milk). Older adults (> or = 50 years) displayed a significantly higher incidence (46%) of lactose maldigestion than younger adults (< 50 years, 26%). In younger adults there were 2.4 times more maldigesters in blacks than in whites, while in older groups this ratio was 3.6. Level of breath hydrogen significantly increased with age up to the age group of 60-69 years. The interaction between age groups and race was highly significant. Of the maldigesters, 63% reported symptoms and 3% of the total sample reported severe symptoms. Results of this study indicate that the prevalance of lactose maldigestion significantly increases with age in blacks compared to whites and that the magnitude of the problem may be greater in black maldigesters than in white maldigesters.

Adult↗