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Angima G, Qu Y, Park SH, Dallas DC. Prebiotic Strategies to Manage Lactose Intolerance Symptoms. Nutrients 2024; 16:1002. [PMID: 38613035 PMCID: PMC11013211 DOI: 10.3390/nu16071002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Lactose intolerance, which affects about 65-75% of the world's population, is caused by a genetic post-weaning deficiency of lactase, the enzyme required to digest the milk sugar lactose, called lactase non-persistence. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. Genetic variations, namely lactase persistence, allow some individuals to metabolize lactose effectively post-weaning, a trait thought to be an evolutionary adaptation to dairy consumption. Although lactase non-persistence cannot be altered by diet, prebiotic strategies, including the consumption of galactooligosaccharides (GOSs) and possibly low levels of lactose itself, may shift the microbiome and mitigate symptoms of lactose consumption. This review discusses the etiology of lactose intolerance and the efficacy of prebiotic approaches like GOSs and low-dose lactose in symptom management.
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Affiliation(s)
- Gloria Angima
- Department of Food Science & Technology, Oregon State University, Corvallis, OR 97331, USA; (G.A.); (Y.Q.)
| | - Yunyao Qu
- Department of Food Science & Technology, Oregon State University, Corvallis, OR 97331, USA; (G.A.); (Y.Q.)
- Nutrition Program, School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, OR 97331, USA
| | - Si Hong Park
- Department of Food Science & Technology, Oregon State University, Corvallis, OR 97331, USA; (G.A.); (Y.Q.)
| | - David C. Dallas
- Department of Food Science & Technology, Oregon State University, Corvallis, OR 97331, USA; (G.A.); (Y.Q.)
- Nutrition Program, School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, OR 97331, USA
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Jo IH, Paik CN, Kim YJ, Lee JM, Choi SY, Hong KP. Lactase Deficiency Diagnosed by Endoscopic Biopsy-based Method is Associated With Positivity to Glucose Breath Test. J Neurogastroenterol Motil 2023; 29:85-93. [PMID: 36606439 PMCID: PMC9837539 DOI: 10.5056/jnm22023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 01/07/2023] Open
Abstract
Background/Aims Lactase deficiency, which has many similarities with small intestinal bacterial overgrowth (SIBO), causes various gastrointestinal symptoms. We estimate the prevalence of SIBO in patients with intestinal symptoms from dairy products and investigate the association between lactase deficiency (LD) and SIBO. Methods This prospective study included patients with functional intestinal symptoms from dairy product indigestion. A questionnaire on gastrointestinal symptoms, a hydrogen (H2)-methane glucose breath test (GBT) for SIBO, and lactose intolerance quick test (LQT) for LD using upper gastrointestinal endoscopy were performed. Results A total of 88 patients, 29 (33.0%) with severe and 36 (40.9%) with mild LD were included. Sixteen patients (18.2%) were GBT positive. Patients with LQT negativity indicating severe LD showed a higher positivity to GBT or GBT (H2) than the historic controls (27.6% vs 6.7%, P = 0.032). There was no difference in the items on the symptom questionnaire according to the presence of LD or SIBO, except for higher symptom scores for urgency in GBT-positive patients. There were more LQT-negative patients in the GBT (H2)-positive group than in the other groups (27.6% vs 10.2%, P = 0.036). Moreover, only GBT (H2)-positivity was significantly associated with a higher risk of LQT negativity in multivariate analysis (OR, 4.19; P = 0.029). Conclusions SIBO producing H2 is common in patients with severe LD suspected lactose intolerance. SIBO may be a new therapeutic target for managing intestinal symptoms in patients with lactose intolerance.
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Affiliation(s)
- Ik Hyun Jo
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Nyol Paik
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Correspondence: Chang-Nyol Paik, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu Daero (Ji-dong), Suwon Si, Paldal-gu, Gyeonggi-do 16247, Korea, Tel: +82-31-881-8582, Fax: +82-31-253-8898, E-mail:
| | - Yeon-Ji Kim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Min Lee
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Choi
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Pyung Hong
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Catanzaro R, Sciuto M, Marotta F. Lactose intolerance: An update on its pathogenesis, diagnosis, and treatment. Nutr Res 2021; 89:23-34. [PMID: 33887513 DOI: 10.1016/j.nutres.2021.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
Lactose intolerance has a high prevalence worldwide, ranging between 57% and 65%. It is caused by a reduction or loss of the activity of the intestinal enzyme lactase-phlorizin hydrolase, responsible for the digestion of lactose. This alteration determines an increased osmotic load in the small intestine and the fermentation of lactose by the bacterial flora, which leads to a high production of short-chain fatty acids and gas. This is followed by the onset of abdominal pain, diarrhea, and flatulence. In addition to these problems, it was found that subjects with lactose intolerance have an increased risk of developing various extra-intestinal diseases, including cancers. The diagnosis is essential to undertake an adequate treatment and, for this purpose, different methods have been tested. These include genetic test, hydrogen breath test (HBT), quick lactase test, and lactose tolerance test. HBT is the most used method because it is non-invasive, inexpensive, and highly sensitive and specific, as well as easy to perform. In clinical practice, the other methods are mainly used as HBT integration tests. There are also many therapeutic options. An appropriate intervention concerns the dietetic style, such as the consumption of lactose-free foods, but with nutritional characteristics comparable to dairy products. Other valid choices are represented by the use of exogenous enzymes, probiotics, prebiotics, the selection of milk containing specific types of beta-caseins. This review is intended to illustrate the diagnostic methods currently available and the possible therapeutic options for lactose intolerance.
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Affiliation(s)
- Roberto Catanzaro
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Catania, Italy.
| | - Morena Sciuto
- Department of Clinical and Experimental Medicine, Gastroenterology Section, "Gaspare Rodolico" Policlinico Hospital, University of Catania, Catania, Italy.
| | - Francesco Marotta
- ReGenera R&D International for Aging Intervention & San Babila Clinic, Milano, Italy.
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Reed RC, Pacheco MC. Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens. Am J Clin Pathol 2019; 152:742-746. [PMID: 31332425 DOI: 10.1093/ajcp/aqz091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency. METHODS A retrospective chart review analyzed 1,678 DS results in children, biopsy indication(s), and duodenal histopathology. RESULTS One or more DSs were abnormal in 42.8%. Sufficient lactase predicted sucrase, palatinase, and maltase sufficiency (negative predictive value 97.7%). Three patients had sucrase-isomaltase deficiency (0.2%). DS deficiency was more common in biopsy specimens for positive celiac serology (78.0%). Villous blunting, intraepithelial lymphocytosis, and active inflammation predicted DS deficiency; a combination of any two had an 81.4% positive predictive value. CONCLUSIONS Utilization could be reduced by only testing cases with normal duodenal histopathology and ongoing clinical suspicion for DS deficiency after reviewing pathology. In cases with suspected celiac disease and/or mucosal injury, DS deficiency is common and likely secondary, limiting test utility.
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Affiliation(s)
- Robyn C Reed
- Department of Laboratory Medicine and Pathology, Children’s Hospitals and Clinics of Minnesota, Minneapolis
| | - M Cristina Pacheco
- Department of Pathology, Microbiology & Immunology, Division of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Pathology, University of Washington, Seattle
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Rojo C, Jaime F, Azócar L, Hernández C, Villagrán A, Miquel JF, Arancibia G. Concordance between Lactose Quick Test, hydrogen-methane breath test and genotyping for the diagnosis of lactose malabsorption in children. Neurogastroenterol Motil 2018; 30:e13271. [PMID: 29266556 DOI: 10.1111/nmo.13271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lactose intolerance is a frequent condition in certain populations. Different methods for diagnosis exist. There is scarce literature regarding Lactose Quick Test (LQT) and concordance with other methods for lactose intolerance diagnosis in children. METHODS Prospectively, we included children who underwent gastroduodenoscopy for evaluation of abdominal pain. We obtained a duodenal sample for LQT and blood sample for genetic test to evaluate LCT C>T-13910 variant. Later, patients underwent breath test with lactose, to evaluate malabsorption. We evaluated the concordance between the three different tests. KEY RESULTS We included 46 patients, 56.5% women. Mean age was 13.2 years (range 9-18 years). 66.6% of patients had lactose malabsorption according to breath test; 64.4% were homozygous CC; and 91.3% had hypolactasia (mild or severe) according to LQT. None of the patients with normolactasia had altered breath test. Genetic test had a substantial agreement (k = 0.675) with breath test and fair agreement (k = 0.301) with LQT. LQT had fair agreement (k = 0.348) with breath test. CONCLUSIONS & INFERENCES Genetic test had better concordance with breath test than LQT to diagnose lactose malabsorption, however, none of the patients with normal LQT had lactose malabsorption. In patients who undergo gastroduodenoscopy to study abdominal pain, it seems reasonable to perform LQT, and, in those with hypolactasia, to perform breath test.
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Affiliation(s)
- C Rojo
- Faculty of Medicine, Division of Pediatrics, Department of Pediatric Gastroenterology and Nutrition, Pontificia Universidad Católica de Chile, Santiago, Chile.,Hospital Regional Leonardo Guzmán, Antofagasta, Chile
| | - F Jaime
- Faculty of Medicine, Division of Pediatrics, Department of Pediatric Gastroenterology and Nutrition, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Azócar
- Faculty of Medicine, Departament of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Hernández
- Faculty of Medicine, Division of Pediatrics, Department of Pediatric Gastroenterology and Nutrition, Laboratory of Gastrointestinal Infections and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Villagrán
- Faculty of Medicine, Division of Pediatrics, Department of Pediatric Gastroenterology and Nutrition, Laboratory of Gastrointestinal Infections and Immunology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J F Miquel
- Faculty of Medicine, Departament of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - G Arancibia
- Faculty of Medicine, Division of Pediatrics, Department of Pediatric Gastroenterology and Nutrition, Pontificia Universidad Católica de Chile, Santiago, Chile
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Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2:738-746. [PMID: 28690131 DOI: 10.1016/s2468-1253(17)30154-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies have shown wide variation in the prevalence of lactose malabsorption across the world, but no systematic reviews or meta-analyses have recently assessed the prevalence of lactose malabsorption in different geographical areas. We aimed to present an updated systematic review and meta-analysis on the prevalence of lactose malabsorption in adults, by countries and regions, and to assess the variation between different testing methods. METHODS Studies reporting on prevalence of lactose malabsorption and lactase persistence were identified by searching MEDLINE and Embase from database inception to Nov 2, 2016. We evaluated studies presenting lactose malabsorption or lactase persistence prevalence data in adults and children aged 10 years or older, including cross-sectional and prospective studies, using genotyping, hydrogen breath tests, lactose tolerance tests, and other testing methods. We excluded studies in children younger than 10 years, studies using self-reported data, and studies including inpatients and outpatients at gastroenterological wards. Studies were screened by two authors (CLS and SKF) and data values were extracted by two authors (CLS and SKF) independently. The primary outcome was the prevalence of lactose malabsorption. This study is registered with PROSPERO, number CRD42017064802. FINDINGS We screened 2665 records, and 306 study populations from 116 full-text articles were included (primary sources); data for 144 additional study populations from 59 articles were obtained from review articles, because full-text primary articles could not be obtained (secondary sources). Of the 450 study populations included, 231 were assessed by genotyping, 83 by hydrogen breath tests, 101 by lactose tolerance tests, and 35 by other methods or methods that were not described sufficiently. The studies included 62 910 participants from 89 countries (covering 84% of the world's population). When standardising for country size, the global prevalence estimate of lactose malabsorption was 68% (95% CI 64-72), ranging from 28% (19-37) in western, southern, and northern Europe to 70% (57-83) in the Middle East. When assessing the global prevalence using genotyping data only, the estimate was 74% (69-80), whereas prevalence was 55% (46-65) using lactose tolerance test data, and 57% (46-67) using hydrogen breath test data. Risk of bias was assessed based on ten indicators; 12 of the articles had a score of ten, indicating low risk of bias, 76 had a score of nine, 26 a score of eight, and two articles a score of seven (indicating higher risk of bias). There was substantial heterogeneity between studies within most of the assessed countries. INTERPRETATION Lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. Acknowledging regional patterns of lactose malabsorption is important to guide management of gastrointestinal symptoms. FUNDING None.
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Marie I, Leroi AM, Gourcerol G, Levesque H, Menard JF, Ducrotte P. Lactose malabsorption in systemic sclerosis. Aliment Pharmacol Ther 2016; 44:1123-1133. [PMID: 27677253 DOI: 10.1111/apt.13810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are no studies on systemic sclerosis (SSc) assessing the relationship between food intake, especially lactose, and gastrointestinal dysfunction. AIM To determine the prevalence of lactose malabsorption, using lactose breath test, in patients with SSc. To evaluate the correlation between lactose malabsorption and gastrointestinal involvement. To predict which SSc patients exhibit lactose malabsorption. METHODS Seventy-seven consecutive Caucasian patients with SSc and 20 control subjects underwent lactose breath test. All patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. RESULTS The prevalence of lactose malabsorption was higher in SSc patients than in controls (44.3% vs. 10%; P = 0.004). We observed a marked correlation between the presence of lactose malabsorption and: higher values of GSS (P < 0.0001); severe oesophageal (P = 0.018) and small intestinal (P = 0.04) motor disorders; and joint involvement (P = 0.019). Furthermore, in SSc patients with symptomatic lactose malabsorption, the median value of GSS of digestive symptoms was lower after initiation of lactose-free diet (P < 0.0001). CONCLUSIONS Our study underscores the fact that lactose malabsorption often occurs in patients with systemic sclerosis. Furthermore, our findings highlight the fact that lactose breath test is a helpful, noninvasive method, by identifying the group of patients with systemic sclerosis with symptomatic lactose malabsorption that may benefit from a reduction in lactose intake.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | - A-M Leroi
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - G Gourcerol
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - H Levesque
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
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Dzialanski Z, Barany M, Engfeldt P, Magnuson A, Olsson LA, Nilsson TK. Lactase persistence versus lactose intolerance: Is there an intermediate phenotype? Clin Biochem 2015; 49:248-52. [PMID: 26601570 DOI: 10.1016/j.clinbiochem.2015.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/30/2015] [Accepted: 11/02/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND According to the prevailing theory about the genetic background to lactose intolerance, there are three genotypes but only two adult physiological phenotypes: lactase persistence in individuals with the CT and TT genotypes and lactase non-persistence in individuals with the CC genotype. However, analysis of lactase activity from intestinal biopsies has revealed three distinct levels of activity, suggesting that an intermediate physiological phenotype may exist. AIM To assess possible disparities between different genotypes with regard to biomarkers of lactase activity and physical symptoms during an oral lactose load test. METHODS A retrospective study using an oral lactose load test (n=487). Concentrations of hydrogen in exhaled air and blood glucose were measured. Afterwards, subjects were asked to provide oral mucosa samples for genotyping and answer a questionnaire (participation rate 56%, n=274). RESULTS Mean hydrogen levels in exhaled air at 120min were significantly higher in the CT genotype than in the TT genotype. There was no significant difference in blood glucose levels between the two groups. Reported symptoms, with the possible exception of abdominal pain, were equally prevalent in both groups. CONCLUSIONS Subjects with the CT and TT genotypes, hitherto classified as lactase-persistent, differ in their physiological response to lactose intake, indicating differences in phenotype which could have clinical significance.
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Affiliation(s)
- Zbigniew Dzialanski
- University Health Care Research Center, School of Health and Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Michael Barany
- Department of Clinical Physiology, School of Health and Medicine Sciences, Örebro University, SE 701 82 Örebro, Sweden
| | - Peter Engfeldt
- University Health Care Research Center, School of Health and Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Health and Medicine Sciences, Örebro University, SE 701 82 Örebro, Sweden
| | - Lovisa A Olsson
- Department of Clinical Chemistry, School of Health and Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Faculty of Medicine and Health, Umeå University, SE 901 87 Umeå, Sweden
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Raithel M, Weidenhiller M, Hagel AFK, Hetterich U, Neurath MF, Konturek PC. The malabsorption of commonly occurring mono and disaccharides: levels of investigation and differential diagnoses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:775-82. [PMID: 24300825 DOI: 10.3238/arztebl.2013.0775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adverse food reactions (AFR) have has recently attracted increased attention from the media and are now more commonly reported by patients. Its classification, diagnostic evaluation, and treatment are complex and present a considerable challenge in clinical practice. Non-immune-mediated types of food intolerance have a cumulative prevalence of 30% to 40%, while true (immune-mediated) food allergies affect only 2% to 5% of the German population. METHOD We selectively searched the literature for pertinent publications on carbohydrate malabsorption, with special attention to published guidelines and position papers. RESULTS Carbohydrate intolerance can be the result of a rare, systemic metabolic defect (e.g., fructose intolerance, with a prevalence of 1 in 25,000 persons) or of gastrointestinal carbohydrate malabsorption. The malabsorption of simple carbohydrates is the most common type of non-immune-mediated food intolerance, affecting 20% to 30% of the European population. This condition is caused either by deficient digestion of lactose or by malabsorption of fructose and/or sorbitol. Half of all cases of gastrointestinal carbohydrate intolerance have nonspecific manifestations, with a differential diagnosis including irritable bowel syndrome, intolerance reactions, chronic infections, bacterial overgrowth, drug side effects, and other diseases. The diagnostic evaluation includes a nutritional history, an H2 breath test, ultrasonography, endoscopy, and stool culture. CONCLUSION The goals of treatment for carbohydrate malabsorption are to eliminate the intake of the responsible carbohydrate substance or reduce it to a tolerable amount and to assure the physiological nutritional composition of the patient's diet. In parallel with these goals, the patient should receive extensive information about the condition, and any underlying disease should be adequately treated.
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Affiliation(s)
- Martin Raithel
- Department of Medicine 1 - Gastroenterology, Pneumology and Endocrinology, Universitätsklinikum Erlangen, Gastroenterology practice, Regensburg, Department of Internal Medicine II, Thüringen-Klinik Saalfeld, Dietetics Service, University Hospital Erlangen
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Perets TT, Shporn E, Aizic S, Kelner E, Levy S, Bareli Y, Pakanaev L, Niv Y, Dickman R. A diagnostic approach to patients with suspected lactose malabsorption. Dig Dis Sci 2014; 59:1012-6. [PMID: 24357185 DOI: 10.1007/s10620-013-2980-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/28/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND The lactose breath test (LBT) is the standard technique for diagnosis of lactose malabsorption. However, it is time-consuming, strenuous for the patient and has been reported to have low sensitivity. The lactose intolerance quick test (LIQT) measures lactase activity in duodenal biopsies and may be performed as part of upper gastrointestinal endoscopy. AIM The purpose of this study was to assess the role of the LBT and LIQT in the case management of suspected lactose malabsorption. METHODS The study group included 69 consecutive patients evaluated by the LBT followed by the LIQT. The test results were compared, and the sensitivity, specificity, and predictive values of the LBT were calculated. RESULTS Mean age of the patients was 54.4 years, male/female ratio was 1:3, and mean body mass index was 25.2. None had celiac disease on duodenal biopsy. The LIQT was positive for hypolactasia in 55 patients (80 %): mild in 14 (25 %) and severe in 41 (75 %); 10 (18 %) were symptomatic during the LBT. The LBT was positive for lactose malabsorption in 32 patients (46 %). Of the 37 patients with normal findings on the LBT, 24 (65 %) had positive findings on the LIQT: 11 (30 %) mild hypolactasia, 13 (35 %) severe hypolactasia. In one case, the LBT was positive and the LIQT was negative. The LBT had a sensitivity of 56 %, specificity 93 %, positive predictive value 97 %, and negative predictive value 35 %. CONCLUSIONS The LBT may serve as a diagnostic screening tool for lactose malabsorption. Symptomatic patients with negative LBT results should be referred for second-line testing with the LIQT.
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Affiliation(s)
- Tsachi Tsadok Perets
- Laboratory of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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A comparison between lactose breath test and quick test on duodenal biopsies for diagnosing lactase deficiency in patients with self-reported lactose intolerance. J Clin Gastroenterol 2013; 47:148-52. [PMID: 22495813 DOI: 10.1097/mcg.0b013e31824e9132] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND A lactose breath test (LBT) is usually used to diagnose lactase deficiency, and a lactose quick test (LQT) has been proposed as a new test on duodenal biopsies to detect this disorder. GOALS We aimed to assess the diagnostic accuracy of LBT and LQT and their ability to predict the clinical response to a lactose-free diet in patients with self-reported lactose intolerance. STUDY Fifty-five patients (age 47 ± 14 y; M/F 15/36) underwent upper gastrointestinal endoscopy and 25g-LBT. Two duodenal biopsies were taken to determine lactase deficiency (normal, mild, or severe) by LQT and to rule out other causes of secondary lactose malabsorption. Patients with a positive LBT and normal LQT also underwent a glucose breath test to exclude small intestinal bacterial overgrowth as a cause of the former result. The severity of gastrointestinal symptoms was measured with a GSS questionnaire, under basal condition and 1 month after a lactose-free diet. RESULTS Lactose malabsorption was detected in 31/51 patients with LBT and in 37/51 patients with LQT (P = NS). Celiac disease was found in 2 patients. Two LBT+ patients showed a positive glucose breath test for small intestinal bacterial overgrowth. Eight patients had a mild hypolactasia by LQT and a negative LBT, but they had a significant improvement of symptoms after diet. LQT and LBT were concordant in 83% of cases and predicted the response to a lactose-free diet in 98% and 81% of the cases, respectively (P = 0.03). CONCLUSIONS LQT is as sensitive as LBT in detecting lactase deficiency; however, it seems to be more accurate than LBT in predicting the clinical response to a lactose-free diet.
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Mattar R, Basile-Filho A, Kemp R, Santos JSD. Comparison of Quick Lactose Intolerance Test in duodenal biopsies of dyspeptic patients with single nucleotide polymorphism LCT-13910C>T associated with primary hypolactasia/lactase-persistence. Acta Cir Bras 2013; 28 Suppl 1:77-82. [DOI: 10.1590/s0102-86502013001300015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To analyze the usefulness of Quick Lactose Intolerance Test in relation to the genetic test based on LCT-13910C>T genotypes, previously validated for clinical practice, for primary hypolactasia/lactase-persistence diagnosis. METHODS: Thirty-two dyspeptic patients that underwent upper gastrointestinal endoscopy entered the study. Two postbulbar duodenal biopsies were taken for the Quick test, and gastric antral biopsy for DNA extraction and LCT-13910C>T polymorphism analysis. DNA was also extracted from biopsies after being used in the Quick Test that was kept frozen until extraction. RESULTS: Nine patients with lactase-persistence genotype (LCT-13910CT or LCT-13910TT) had normolactasia, eleven patients with hypolactasia genotype (LCT-13910CC) had severe hypolactasia, and among twelve with mild hypolactasia, except for one that had LCT-13910CT genotype, all the others had hypolactasia genotype. The agreement between genetic test and quick test was high (p<0.0001; Kappa Index 0.92). Most of the patients that reported symptoms with lactose-containing food ingestion had severe hypolactasia (p<0.05). Amplification with good quality PCR product was also obtained with DNA extracted from biopsies previously used in the Quick Test; thus, for the future studies antral gastric biopsies for genetic test would be unnecessary. CONCLUSION: Quick test is highly sensitive and specific for hypolactasia diagnosis and indicated those patients with symptoms of lactose intolerance.
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Abstract
Most people are born with the ability to digest lactose, the major carbohydrate in milk and the main source of nutrition until weaning. Approximately 75% of the world’s population loses this ability at some point, while others can digest lactose into adulthood. This review discusses the lactase-persistence alleles that have arisen in different populations around the world, diagnosis of lactose intolerance, and its symptomatology and management.
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Affiliation(s)
- Rejane Mattar
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Comparison of quick point-of-care test for small-bowel hypolactasia with biochemical lactase assay in children. J Pediatr Gastroenterol Nutr 2012; 54:401-3. [PMID: 21857246 DOI: 10.1097/mpg.0b013e318231eb30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
AIM The aim of the present study was to compare the Biohit Lactose Intolerance Quick Test (BLIQT) to the criterion standard biochemical duodenal lactase (DL) activity assay in the paediatric population using standard statistical comparative tests. METHODS Using standard Olympus endoscopes, 2 postbulbar duodenal biopsies were taken from 38 prospective children (0-16 years) from June 2008-May 2009 at a single tertiary paediatric gastroenterology unit. The biopsies were used for the BLIQT and for biochemical disaccharides assay. RESULTS Thirty-eight children (19 boys) of median age 5.45 years (0.3-14.8 years) underwent the combined BLIQT and disaccharidase testing. We subdivided the group into those who had biopsies with a larger endoscope (XQ, n = 26) and those who had a smaller endoscope (XP, n = 12) and thus a smaller biopsy forcep. When using a larger endoscope, the BLIQT showed a sensitivity of 100%, specificity of 86%, and positive and negative predictive value of 57.1% and 100%, respectively, on comparing it with DL. With a smaller endoscope, the BLIQT had a sensitivity of 100%, specificity of 80%, positive predictive value of 50%, and a negative predictive value of 100%. CONCLUSIONS As in adult studies, the sensitivity and negative predictive value of the BLIQT was 100%. The specificity too appears to be high but variable, probably because of smaller biopsies obtained, and may warrant the need for 2 biopsies. The high sensitivity, specificity, and negative predictive value of the BLIQT for indicating hypolactasia make it an effective point-of-care test for paediatric hypolactasia.
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Quick test: a new test for the diagnosis of duodenal hypolactasia. Dig Dis Sci 2008; 53:1589-92. [PMID: 17932760 DOI: 10.1007/s10620-007-0027-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 09/19/2007] [Indexed: 12/30/2022]
Abstract
The hydrogen (H2) lactose breath test (BT) is a test commonly used for the diagnosis of hypolactasia. However, its sensitivity is not always good. In the last few years, the new Quick Lactase Test (QLT) has been developed for endoscopic diagnosis of adult-type hypolactasia. The aim of this study was to compare the efficacy of the new QLT with the traditional H2 lactose BT for the diagnosis of hypolactasia. Fifty dyspeptic patients (19 male, 31 female, mean age 38 +/- 6) were enrolled in the study. All the patients were subjected to the H2 lactose BT and to upper gastrointestinal endoscopy. Two postbulbar duodenal biopsies were used for the QLT (Biohit, Helsinki, Finland). The duodenum biopsies were incubated with lactose on a test plate: in patients with normolactasia a colour reaction develops as a result of hydrolysed lactose (positive result), whereas no reaction develops in patients with mild or severe hypolactasia (negative results). Twenty-two out of 50 patients (44%) had a positive H2 lactose BT. Among them, 21 showed a mild or severe hypolactasia with the QLT. When we considered patients with a negative H2 lactose BT (28 out of 50), 24 patients showed normal lactase activity in duodenal biopsies with the QLT, whereas in 4 patients there was discordance between the two tests. These patients were re-evaluated with a methane (CH4) and an H2 lactose BT and 3 of them were H2 non-producers with a high level of CH4 production. Only 1 patient with a negative result in the QLT remains negative to lactose BT. Our study showed a good correlation between the H2 lactose BT and the new QLT in the diagnosis of adult-type hypolactasia for the majority of patients. However, the QLT seems to be more sensitive than the H2 lactose BT, helping to identify a subgroup of patients with adult-type hypolactasia with a negative result in the H2 lactose BT. Based on these results we suggest performing the less expensive and more rapid QLT during the upper gastrointestinal endoscopy to evaluate the presence of lactase activity in duodenal biopsies.
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Imtiaz F, Savilahti E, Sarnesto A, Trabzuni D, Al-Kahtani K, Kagevi I, Rashed MS, Meyer BF, Järvelä I. The T/G 13915 variant upstream of the lactase gene (LCT) is the founder allele of lactase persistence in an urban Saudi population. J Med Genet 2007; 44:e89. [PMID: 17911653 PMCID: PMC2597971 DOI: 10.1136/jmg.2007.051631] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of lactase persistence is high in Saudi Arabia. OBJECTIVE To identify a DNA variant for the lactase persistence/non-persistence trait in adult Arabs in Saudi Arabia. METHODS We sequenced DNA from 432 anonymous neonatal blood donors from five different regions of Saudi Arabia to cover the 400 bp region surrounding the previously identified lactase persistence/non-persistence variant C/T-13910 residing in intron 13 of the MCM6 gene. RESULTS Two anonymous blood donors carried the C/T-13910 genotype. One variant, T/G -13915, residing 5 bp upstream of the C/T-13910 variant, was present in 332 of 432 (76.9%) of the neonatal samples, compatible with previous prevalence figures of lactase persistence in urban Saudi populations. Determination of disaccharidase activities in 25 intestinal biopsy samples showed a highly significant correlation between lactase activity and the T/G-13915 genotypes (p<0.001; Fisher exact test) as well as between the L:S ratio and the aforementioned genotypes (p<0.001; Fisher exact test). CONCLUSION The T/G-13915 variant is the founder mutation of lactase persistence in an urban Saudi population. The results obtained here have implications for genetic testing of adult-type hypolactasia and to analysis of human evolution, the origin of cattle domestication and migrations of the populations in the Arabian peninsula.
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Affiliation(s)
- F Imtiaz
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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