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Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance.

Abstract

BACKGROUND

The relationship between lactose malabsorption, irritable bowel syndrome and development of intestinal symptoms is unclear, especially when the ingested dose of milk is small. Thus, the role of hydrogen breath testing in the diagnostic work-up of patients with nonspecific intestinal symptoms is still debated.

AIMS

To establish the relationship between lactose malabsorption, severe self-reported milk intolerance, irritable bowel syndrome and related symptoms.

METHODS

The prevalence of lactose malabsorption was prospectively assessed by means of a hydrogen breath test in 839 patients (503 with irritable bowel syndrome, based on the Rome criteria, regularly consuming milk, and 336 subjects who identified themself as milk intolerant, after an oral load of 25 g lactose). The test was considered "positive" when a hydrogen peak exceeding 20 ppm over baseline values was observed in two or more samples. Attempts were also made to establish whether the predominant presenting symptom (diarrhoea, constipation, alternating diarrhoea and constipation, pain and gaseousness) might be helpful in predicting the outcome of the breath test.

RESULTS

The prevalence of a positive breath test was comparable in the two groups (337 patients with irritable bowel syndrome (66.9%) vs 240 patients with milk intolerance (71.4%)). The same holds true for the first peak of hydrogen excretion, total hydrogen output and prevalence of symptoms during, and in the four hours after, the test. The predominant presenting symptom was not useful for predicting outcome of the test either in regular milk users or in milk intolerant subjects.

CONCLUSIONS

The almost identical results of the lactose breath test of patients with irritable bowel syndrome and subjects with self-reported milk intolerance suggests that the two conditions overlap to such an extent that the clinical approach should be the same. A lactose breath test should always be included in the diagnostic work-up for irritable bowel syndrome, as fermentation of malabsorbed lactose is likely responsible for triggering symptoms. Conversely, lactase deficiency is probably irrelevant in most subjects not affected by irritable bowel syndrome, within a moderate milk consumption.

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  • Authors+Show Affiliations

    ,

    Chair of Gastroenterology 1, La Sapienza University, Rome, Italy. vernia@uniroma1.it

    ,

    Source

    MeSH

    Adolescent
    Adult
    Breath Tests
    Colonic Diseases, Functional
    Comorbidity
    Female
    Humans
    Lactose Intolerance
    Malabsorption Syndromes
    Male
    Middle Aged
    Milk Hypersensitivity
    Patient Participation
    Predictive Value of Tests
    Prevalence
    Prospective Studies
    Risk Assessment

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    11407668

    Citation

    Vernia, P, et al. "Lactose Malabsorption, Irritable Bowel Syndrome and Self-reported Milk Intolerance." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 33, no. 3, 2001, pp. 234-9.
    Vernia P, Di Camillo M, Marinaro V. Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance. Dig Liver Dis. 2001;33(3):234-9.
    Vernia, P., Di Camillo, M., & Marinaro, V. (2001). Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 33(3), pp. 234-9.
    Vernia P, Di Camillo M, Marinaro V. Lactose Malabsorption, Irritable Bowel Syndrome and Self-reported Milk Intolerance. Dig Liver Dis. 2001;33(3):234-9. PubMed PMID: 11407668.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lactose malabsorption, irritable bowel syndrome and self-reported milk intolerance. AU - Vernia,P, AU - Di Camillo,M, AU - Marinaro,V, PY - 2001/6/16/pubmed PY - 2001/11/3/medline PY - 2001/6/16/entrez SP - 234 EP - 9 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 33 IS - 3 N2 - BACKGROUND: The relationship between lactose malabsorption, irritable bowel syndrome and development of intestinal symptoms is unclear, especially when the ingested dose of milk is small. Thus, the role of hydrogen breath testing in the diagnostic work-up of patients with nonspecific intestinal symptoms is still debated. AIMS: To establish the relationship between lactose malabsorption, severe self-reported milk intolerance, irritable bowel syndrome and related symptoms. METHODS: The prevalence of lactose malabsorption was prospectively assessed by means of a hydrogen breath test in 839 patients (503 with irritable bowel syndrome, based on the Rome criteria, regularly consuming milk, and 336 subjects who identified themself as milk intolerant, after an oral load of 25 g lactose). The test was considered "positive" when a hydrogen peak exceeding 20 ppm over baseline values was observed in two or more samples. Attempts were also made to establish whether the predominant presenting symptom (diarrhoea, constipation, alternating diarrhoea and constipation, pain and gaseousness) might be helpful in predicting the outcome of the breath test. RESULTS: The prevalence of a positive breath test was comparable in the two groups (337 patients with irritable bowel syndrome (66.9%) vs 240 patients with milk intolerance (71.4%)). The same holds true for the first peak of hydrogen excretion, total hydrogen output and prevalence of symptoms during, and in the four hours after, the test. The predominant presenting symptom was not useful for predicting outcome of the test either in regular milk users or in milk intolerant subjects. CONCLUSIONS: The almost identical results of the lactose breath test of patients with irritable bowel syndrome and subjects with self-reported milk intolerance suggests that the two conditions overlap to such an extent that the clinical approach should be the same. A lactose breath test should always be included in the diagnostic work-up for irritable bowel syndrome, as fermentation of malabsorbed lactose is likely responsible for triggering symptoms. Conversely, lactase deficiency is probably irrelevant in most subjects not affected by irritable bowel syndrome, within a moderate milk consumption. SN - 1590-8658 UR - https://www.unboundmedicine.com/medline/citation/11407668/Lactose_malabsorption_irritable_bowel_syndrome_and_self_reported_milk_intolerance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(01)80713-1 DB - PRIME DP - Unbound Medicine ER -