Concordance of Indirect Methods for the Detection of Lactose Malabsorption in Diabetic and Nondiabetic Subjects

Lerch, Markus M.; Rieband, H C; Feldberg, Winfried; Matern, Siegfried

doi:10.1159/000200677

Cited by 13 publications

(3 citation statements)

References 24 publications

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“…Therefore, measuring blood glucose during HBT is not always helpful in confirming LM. Furthermore, it is known that such measurements have limitations in diabetic patients [12], since factors other than glucose absorption can cause an increase of more than 20 mg dL −1 in blood glucose. However, in the opposite situation, namely HBT-negative results, blood glucose concentrations showed relevant increases in 14 of 17 patients, thus largely confirming the HBT results and aiding in LM exclusion.…”

Section: Patients With Positive Hbt May Have a Normal Increase In Glu...mentioning

confidence: 99%

Diagnosing lactose malabsorption in children: difficulties in interpreting hydrogen breath test results

et al. 2016

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Lactose malabsorption (LM) is caused by insufficient enzymatic degradation of the disaccharide by intestinal lactase. Although hydrogen (H2) breath tests (HBTs) are routinely applied to diagnose LM, false-negative results are not uncommon. Thirty-two pediatric patients (19 females, 13 males) were included in this prospective study. After oral lactose administration (1 g kg(-1) bodyweight to a maximum of 25 g), breath H2 was measured by electrochemical detection. HBT was considered positive if H2 concentration exceeded an increase of ⩾20 ppm from baseline. In addition to H2, exhaled methane (CH4), blood glucose concentrations and clinical symptoms (flatulence, abdominal pain, diarrhea) were monitored. A positive HBT indicating LM was found in 12/32 (37.5%) patients. Only five (41.7%, 5/12) of these had clinical symptoms during HBT indicating lactose intolerance (LI). Decreased blood glucose concentration increments (⩽20 mg dL(-1) (⩽1.1 mmol L(-1))) were found in 3/5 of these patients. CH4 concentrations ⩾10 ppm at any time during the test were observed in 5/32 (15.6%) patients and in 9/32 (28.1%) between 1 ppm and 9 ppm above baseline after lactose ingestion. In patients with positive HBT 10/12 (83.3%) showed elevated CH4 (>1 ppm) above baseline in breath gas, whereas in patients with negative HBT this figure was only 4/17 (23.5%). In addition to determining H2 in exhaled air, documentation of clinical symptoms, measurement of blood glucose and breath CH4 concentrations may be helpful in deciding whether in a given case an HBT correctly identifies patients with clinically relevant LM.

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Section: Patients With Positive Hbt May Have a Normal Increase In Glu...mentioning

confidence: 99%

Diagnosing lactose malabsorption in children: difficulties in interpreting hydrogen breath test results

et al. 2016

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“…In 5 of the 26 studies, LHBT was not the single reference standard to diagnose lactose malabsorption; these studies additionally used the results of methane excretion, a lactose tolerance test, biopsy, diet, X-ray. 19,23,25,27,33 An oral lactose load of 50 g was used in 18 studies, [18][19][20][21][22]24,[26][27][28][29][30][31][32][33][34][35][36][37] while the dose was not reported in one study. 23 Methodological quality of included studies On average, the reviewers disagreed in 3 out of 11 items (range 1-6).…”

Section: [Table 2]mentioning

confidence: 99%

Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance

Jellema

Schellevis

Windt

et al. 2010

QJM

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“…The most commonly used cut-off point for the increase in glucose concentrations with respect to baseline concentrations is 20 mg/dL [12], although 15 mg/dL has been reported to have better sensibility and specificity [7,13]. An important limitation is that this test is not valid or indicated for diabetic patients [14], and bacterial overgrowth can interfere with its interpretation.…”

Section: Introductionmentioning

confidence: 99%

Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption

Sendino

Sandúa

Calleja

et al. 2020

Advances in Laboratory Medicine / Avances en Medicina De Laboratorio

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ObjectivesLactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H2B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H2B concentrations.MethodsA total of 430 patients (40 years, Q1–Q3 = 28–54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively.ResultsH2B was <10 ppm in 69.5% of subjects; 10–20 ppm in 14.7%; and >20 ppm in 15.8% of subjects. In patients with H2B <20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=−0.389; p<0.05). The increase in glycemia during LTT was not influenced by H2B levels obtained in HBT.ConclusionsLTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H2B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.

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Concordance of Indirect Methods for the Detection of Lactose Malabsorption in Diabetic and Nondiabetic Subjects

Cited by 13 publications

References 24 publications

Diagnosing lactose malabsorption in children: difficulties in interpreting hydrogen breath test results

Diagnosing lactose malabsorption in children: difficulties in interpreting hydrogen breath test results

Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance

Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption

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