Association between milk consumption and lactose malabsorption in Indonesian children / 中国当代儿科杂志

OBJECTIVES@#To study the association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years.@*METHODS@#This cross sectional study was conducted in randomly selected presumed healthy children with good nutritional status aged 3-12 years in Central Jakarta, Indonesia (@*RESULTS@#The prevalence of lactose malabsorption in children aged 3-5 years and children aged 6-12 years was 20.8% (15/72) and 35.3% (36/102), respectively. There was no association between milk or milk product consumption and lactose malabsorption (@*CONCLUSIONS@#There is no association between milk consumption and lactose malabsorption in Indonesian children aged 3-12 years, suggesting that genetic predisposition may be more important than adaptive mechanisms to lactose consumption.

High Prevalence of Small Intestinal Bacterial Overgrowth in Lactose Intolerance Patients: Is It a Chicken and Egg Situation.

Background: Lactose intolerance is highly prevalent in Mediterranean area. Substantial portions of patients remain symptomatic in spite of fair lactose-free diet. Aims: Assess in a series of IBS consecutive patients: 1) the prevalence of lactose intolerance; 2) the frequency of association of lactose intolerance with SIBO; 3) the possibility of SIBO as a cause of symptom persistence in patients with lactose intolerance on lactose-free diet; 4) the ability of LHBT to diagnose SIBO. Place and Duration of the Study: Patients were recruited from November 2011 to July 2012 at the Gastroenterology Unit of Mauriziano Hospital U.Ist , Turin, Italy. Methodology: Lactose malabsorption was assessed by means of LHBT and SIBO by means of GHBT and LHBT, using Breath Tracker digital microlyzer on 500 IBS patients and 50 controls. SIBO was treated, with rifaximin 1200 mg a day for 2 weeks, randomly, on 1 to 1 basis. Results: Prevalence of lactose intolerance resulted to be 59% in IBS patients and 6% in controls, with a statistically significant difference (p<.001). SIBO was present in 72% of patients with lactose intolerance in IBS group, ad in none of the subjects with lactose malabsorption (3) in control group. After 6 months, 105 out of 106 patients affected by LI + SIBO treated with rifaximin + lactose free diet, and 34 out of 107 patients affected by LI + SIBO treated only with a lactose free diet resulted completely asymptomatic. Concordance between LHBT and GHBT for SIBO diagnosis was 98%. Conclusions: Lactose intolerance is a common condition in patients with IBS in Northwest Italy (59%) very frequently associated with SIBO (72%). This association turned out to be a major cause of symptom persistence in patients on lactose-free diet until successful eradication of SIBO was achieved. LHBT is a simple test able to diagnose simultaneously lactose malabsorption and SIBO.

La prolongación del test de hidrógeno en aire espirado mejora la sensibilidad del diagnóstico de malabsorción de lactosa / Extension of hydrogen breath test improves sensibility of lactose malabsorption diagnosis

Hydrogen breath test (HBT) for diagnosis of lactose malabsorption (LM), is usually performed over a 180 min standard period. However, studies have suggested that extending the observation time, the sensibility of the test is improved. Aims: To determine if the time extension of the lactose hydrogen breath test, can improve sensibility of the test. Patients and method: One thousand and two hundred and ninety three patients were included, mean age 33.1 years (range: 3-90 years), 73.3 percent women, 26.8 percent were younger than 15years. Lactose HBT was performed for a standard period, which was prolonged to 240 min when patients presented a flat curve at 180 min. Results: Seven hundred and thirty one patients (56.5 percent) had a positive breath test for LM during 180 min. The extension of the HBT to 240 min showed an increase of 13.3 percent (p < 0.05) of patients with LM diagnosis. Conclusion: This study shows that an additional hour increases sensibility of the test, and decreases the false negative results.

El test de hidrógeno en aire espirado (TH2) para el diagnóstico de malabsorción de lactosa (ML) se realiza por un período estándar de 180 min. Sin embargo, se ha sugerido que estudios de mayor duración podrían mejorar la sensibilidad del test. Objetivos: Determinar si la prolongación del TH2 con lactosa, puede mejorar la sensibilidad del diagnóstico de ML. Pacientes y Métodos: Se estudiaron 1293pacientes, edad promedio 33,1 años (rango 3 a 90 años), 73.3 por ciento mujeres, 26,8 por ciento menores de15 años. Para determinar la presencia de ML se realizó el TH2 con lactosa estándar, extendiéndolo a 240 min en pacientes con una curva plana a los 180 min. Resultados: Setecientos treinta y un pacientes (56,5 por ciento) tuvieron un TH2 concordante con ML durante el período de 180 min. En aquellos que se extendió el examen a 240 min se observó un aumento de 13,3 por ciento de ML (p< 0,05). Conclusión: Este estudio demuestra que la prolongación del TH2 en una hora mejora la sensibilidad del examen y disminuye el número de falsos negativos.

Lactose hydrogen breath test versus lactose tolerance test in the tropics: Does positive lactose tolerance test reflect more severe lactose malabsorption.

Background: We compared the lactose hydrogen breath (lactose HBT) and lactose tolerance tests (LTT) in their ability to diagnose lactose malabsorption (LM). Methods: Fasting and post-lactose (50 g) breath hydrogen and blood sugar were tested in patients with irritable bowel syndrome (IBS). Persistent rise in breath hydrogen by 20 ppm and failure of blood sugar to rise by >20 mg/dL above basal level, were considered positive lactose HBT and LTT, respectively. Symptoms of diarrhoea, bloating, abdominal pain and flatulence were noted. Results: Of 203 patients, 11 demonstrated high basal breath hydrogen and hence, 192 (age 37±14 years, 134 male) were included in the study. 125 (65%) and 137 (71%) were lactose HBT and LTT positive, respectively. 102/125 lactose HBT positive patients were LTT positive and 35/67 lactose HBT negative patients were LTT positive. 62/192 (32%) developed symptoms following lactose ingestion, which tended to be more in the LTT positive (49/137, 36% vs. 13/55, 24% p=0.07) but not in the lactose HBT positive patients (44/125, 35% vs. 18/ 67, 27% p=0.2). Peak breath hydrogen was higher (38±37 vs. 66±43; p<0.01) in LTT positive than negative patients. Peak level of breath hydrogen inversely correlated (58±43 vs. 10±23; p<0.001) with change in blood glucose following lactose ingestion. Conclusions: Positive LTT is associated with a higher breath hydrogen score than negative LTT. There was a trend towards more frequent symptom development following lactose load in LTT positive but not in lactose HBT positive patients. LTT is an easy and efficient test for diagnosis of LM.

Prevalence of Lactose Malabsorption in Children by Breath Hydrogen Test / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to investigate the age of onset and the prevalence of lactose malabsorption in early childhood in Korea. METHODS: We conducted a study of lactose malabsorption by breath hydrogen test in healthy children aged between 25~96 months old. Standard lactose loading (2 g lactose/kg, maximum 40g) test was done in 129 children and cow's milk (10 mL/kg) loading in 126 children followed by breath sampling of 60 and 120 minutes after the loading. An increase above baseline of 20 ppm or more was used as a criteria for positive responses. RESULTS: The prevalence of lactose malabsorption was 7% in 25~36 months old, 19% in 37~48 months old, 35% in 49~60 months old, 55% in 61~72 months old, 82% in 72~84 months old, 80% in 85~96 months old children. Only 1% of the children showed positive result in breath hydrogen test after the cow's milk challenge. CONCLUSION: The prevalence of lactose malabsorption was increased between 37 months and 60 months of age, reached to adult level of prevalence after 72 months of age. When physiological dose of lactose was used as the challenge, the number of lactose malabsorbers become clinically insignificant.

Lactose intolerance in lactase - deficient subjects and patients with inflammatory bowel disease after drinking common doses of milk / 대한내과학회지

OBJECTIVE: To define whether lactase-deficient subjects are intolerable to even a pack of milk(200ml) and whether milk intolerance in the patients with IBD is only due to lactose malabsorption, we performed this study. METHODS: We evaluated 32 healthy adults and 12 patients with active stage of inflammatory bowel disease(IBD) who had not received antibiotics therapy within the previous 3 weeks. Thirty-two healthy adults underwent H2-breath test with 200, 400, 600 and 800ml of milk at 1st, 2nd, 3rd and 4th day of study, respectively. We measured their end-expiratory hydrogen concentrations and asked them to record the gastrointestinal symptoms. Twelve patients with IBD were tested only with 200ml of milk. Lactose malabsorption was defined as the increase of 20ppm over basal H2 concentration and lactose intolerance as having two or more of the following symptoms; abdominal pain, diarrhea, borborygmus and flatus. RESULTS: The prevalence of lactase deficiency was 72%(23 of 32 subjects) at 800ml of milk(lactose 40g). Among the lactase-deficient subjects, lactose intolerance at 200ml of milk(lactose 10g) was noticed only in 13%(3 of 23 subjects). In the patients with active stage of IBD, the frequency of milk intolerance at 200ml of milk was 50%(6 of 12 subjects), which was higher than in the healthy adults(9%). But the prevalence of lactose malabsorber in the patients with IBD at 200ml of milk(17%) was not higher than in the healthy adults(16%). CONCLUSION: Most of lactase-deficient subjects(87%) can ingest one pack of milk without lactose intolerance. The increased prevalence of lactose intolerance in the patients with IBD at 200ml of milk is not originated from lactose malabsorption, but probably from incomplete colonic compensation salvage.