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PubMed1976

Intestinal pH and propulsion: an explanation of diarrhoea in lactase deficiency and laxation by lactulose.

Subjects deficient in lactase may experience bloating, cramps and diarrhoea after ingesting milk, due to the unhydrolysed and poorly-absorbed lactose. The diarrhoea may result from an osmotic effect of the lactose itself or its poorly-absorbed acidic products of fermentation (Weijers, van de Kamer & others, 1961; Christopher & Bayless, 1971), possibly together with an alteration of sodium and water absorption due to the lowered colonic pH (Rousseau & Sladen, 1971). Laxation by lactulose (1-4-beta-galactosidofructose) may operate through an analogous mechanism. The drug is a synthetic dissaccharide which, in oral doses of 10-20 g, relieves chronic constipation (Wesselius-de Casparis, Braadbaart & others, 1968). It is neither hydrolysed by intestinal dissaccharidase (Dahlqvist & Gryboski, 1965) nor absorbed in the gut, but it is converted in the colon mainly to lactic and acetic acids by various bacteria including Lactobacillus acidophilus. Apart from the increased osmotic effect, the pH in the proximal colon falls markedly (Bown, Gibson & others, 1974), and larger doses may reduce stool pH. Weijers & others (1961) inferred that the acidic products formed from lactose in the colon stimulate propulsion, and K.S. Liem (Philips-Duphar) suggested to us that lactulose may relieve constipation partly by stimulation of propulsion due to the lowered pH. The experiments described below support this view.

Animals↗
PubMed1985

Neurovisceral and skeletal GM1-gangliosidosis in dogs with beta-galactosidase deficiency.

Beta-galactosidase-deficient siblings in two litters of English springer spaniel puppies showed a progressive neurological impairment, dwarfism, orbital hypertelorism, and dysostosis multiplex. An excess of GM1-ganglioside was found in the brain. Three abnormal oligosaccharides were present in samples of urine, brain, liver, and cartilage. Light microscopy of selected tissue specimens revealed cytoplasmic vacuoles in neurons, circulating blood cells, macrophages, and chondrocytes. Ultrastructural studies demonstrated that these membrane-bound vacuoles were of two types--one containing lamellated membranes and the other, finely granular material. These clinical and pathological findings are similar to those observed in human patients affected by the infantile form of GM1-gangliosidosis.

Animals↗
PubMed1975

Effect of lactose-induced diarrhoea on absorption of nitrogen and fat.

The absorption of fat and the absorption and retention of nitrogen were studied in 20 children with kwashiorkor. 13 of the 20 had lactose malabsorption and severe diarrhoea on milk feeds. Fat absorption was not affected by lactose-induced diarrhoea, but nitrogen absorption was impaired. Despite this, nitrogen retention was unaffected and it is concluded that milk and milk products would continue to be used in programmes to eliminate malnutrition.

Child↗
PubMed1976

Thyrotoxicosis in a neonate of a mother with no history of thyroid disease.

A newborn infant had rectal prolapse, congenital lactase deficiency, and temporary neonatal thyrotoxicosis. The thyrotoxicosis was associated with a raised long-acting thyroid stimulator index in a mother with no personal or family history of thyroid or related autoimmune disease. The parents were first cousins.

Female↗
PubMed1979

Breath hydrogen test for detecting lactose malabsorption in infants and children. Prevalence of lactose malabsorption in Japanese children and adults.

The breath hydrogen test (BHT) was adapted for use in young infants and children. The diagnostic criterion of sugar malabsorption in the BHT was determined by oral administration of 0.5 g/kg of unabsorbable sugar (lactulose) to 21 healthy infants and children. A maximum increase in breath hydrogen less than 0.05 ml/min per m2 was observed in all subjects. A good correlation between results by the BHT and by the ordinary lactose tolerance test was obtained after oral administration of 2 g/kg lactose to 21 healthy infants and children, 2 congenital lactase-deficient infants, and 7 adults. Using this test, 80 healthy Japanese infants and children (aged between one month and 15 years) and 18 adults were examined for lactose malabsorption after a dose of 1 g/kg lactose. All infants and children under 2-years old absorbed lactose completely. The incidence of lactose malabsorption was 30% in 3-year, 36% in 4-year, 58% in 5-year, and 86% in 6-year-old children, 85% in schoolchildren, and 89% in adults. Thus the incidence of lactase deficiency gradually increases with age from 3 years, and about 90% of all normal Japanese adults are lactase-deficient.

Adolescent↗
PubMed1980

Sugar malabsorption in healthy neonates estimated by breath hydrogen.

Carbohydrate malabsorption in 110 healthy, term neonates was studied by estimating expired hydrogen (H2) before and after a feed on day 6 or 7. Carbohydrate malabsorption was assumed to be present if the infant excreted > 20 parts per million (ppm) H2. The frequency of carbohydrate malabsorption in 49 breast-fed infants was 25% (n = 12), in 35 infants fed a 7.5% lactose formula it was 31% (n = 11), in 26 infants fed a formula containing 1% lactose and 7.3% maltodextrin it was 15% (n = 4). These differences in frequency were not significant. Peak H2 concentration of the malabsorbers in each group, indicating the degree of carbohydrate malabsorption, was 64, 52, and 32 ppm respectively. The degree of carbohydrate malabsorption did not differ significantly between the breast-fed and the high lactose formula groups, but both groups differed from the low lactose group. H2 excretion was studied for 5 months in an exclusively breast-fed infant. In the first 2 months high concentrations were found and the infant produced 3-5 stools a day. In the next 3 months however, most H2 estimations were normal and only 1-2 stools a week were passed. With the introduction of solids, daily bowel movements promptly reoccurred. Frequency of carbohydrate malabsorption in newborn infants is fairly high and is primarily related to the lactose intake. The frequency and degree of carbohydrate malabsorption were comparable in breast-fed infants and in infants fed on a high lactose formula; this differs from results previously reported.

Bottle Feeding↗
PubMed1983

Recurrent abdominal pain: a psychogenic disorder?

A controlled study of 30 children with recurrent abdominal pain and 30 pain free children failed to show any statistically significant differences between the groups on a variety of psychological variables thought to be associated with psychogenicity. A psychogenic basis has often been assumed as the cause in diagnosis of recurrent abdominal pain when clinical examination and laboratory tests show no organic or medical reason. We emphasise that establishing a psychogenic cause is only indicated where there is positive evidence for psychological factors such as family or school stress, extreme personality characteristics, or modelling of family pain behaviour.

Abdomen↗
PubMed1984

Small bowel function in acute lymphoblastic leukaemia.

Small bowel function before, during, and after treatment for acute lymphoblastic leukaemia was studied in 26 children. A significant impairment of D-xylose absorption was found during treatment. Permeability studies showed a significant decrease in mannitol and a significant increase in lactulose concentrations; five of 20 children tested had evidence of lactose malabsorption, three of whom were symptomatic. Intestinal function abnormalities were greater in children whose methotrexate treatments were separated by 7 day than by 16 day intervals. Only five (19%) children had no abnormal tests. Abnormalities of small bowel function may be treatment induced and this has implications for morbidity from gastrointestinal symptoms, impairment of the mucosal barrier, and malabsorption of both nutrients and drugs leading to malnutrition and suboptimal drug concentrations.

Adolescent↗
PubMed1985

Hydrogen breath test in schoolchildren.

The frequency of negative hydrogen breath tests due to colonic bacterial flora which are unable to produce hydrogen was determined after oral lactulose challenge in 98 healthy Dutch schoolchildren. There was a negative result in 9.2%. The probability of a false normal lactose breath test (1:77) was calculated from these results together with those from a separate group of children with lactose malabsorption (also determined by hydrogen breath test). A study of siblings and mothers of subjects with a negative breath test did not show familial clustering of this condition. Faecal incubation tests with various sugars showed an increase in breath hydrogen greater than 100 parts per million in those with a positive breath test while subjects with a negative breath test also had a negative faecal incubation test. The frequency of a false negative hydrogen breath test was higher than previously reported, but this does not affect the superiority of this method of testing over the conventional blood glucose determination.

Adolescent↗