Effects of Exogenous Lactase Administration on Hydrogen Breath Excretion and Intestinal Symptoms in Patients Presenting Lactose Malabsorption and Intolerance

Abstract

Objective. To establish whether supplementation with a standard oral dose of Beta-Galactosidase affects hydrogen breath excretion in patients presenting with lactose malabsorption. Methods. Ninety-six consecutive patients positive to H2 Lactose Breath Test were enrolled. Mean peak H2 levels, the time to reach the peak H2, the time to reach the cut-off value of 20 ppm, the cumulative breath H2 excretion, the areas under the curve, and a Visual Analogical 10-point Scale for symptoms were calculated. Genotyping of the C/T-13910 variant was carried out. Results. Following the oral administration of Beta-Galactosidase, in 21.88% of the cases, H2 Lactose Breath Test became negative (Group A), while mean peak H2 levels (74.95 ppm versus 7.85), P < 0.0000, in 17.71% (Group B) were still positive, with the H2 level 20 ppm above the baseline, but the peak H2 levels were significantly lower than those observed at the baseline test (186.7 ppm versus 66.64), P < 0.0000, while in 60.41% (Group C) they were still positive with the peak H2 levels similar to those observed at the baseline test (94.43 versus 81.60 ppm). All 96 individuals tested presented the C/C-13910 genotype nonpersistence. Conclusions. The response to oral administration of Beta-Galactosidase in patients with symptoms of lactose malabsorption presents a significant variability.

Lactose Intolerance, Dairy Avoidance, and Treatment Options

“…The results were variable in 96 participants all of whom were genetically lactase deficient. About 22% became negative, in about 18% there was a significant reduction in tested breath hydrogen but in the rest there was no significant difference from baseline [191]. Reductions of symptoms did not follow reduction of hydrogen production suggesting symptomatic improvement may have been due to a placebo effect.…”

Lactose Intolerance: Common Misunderstandings

“…Preliminary data showed an improvement of gastrointestinal symptoms and a decrease of H 2 levels at breath test with the administration of 1,500 U/day of β-galactosidase. However, more data regarding the efficacy of this microbial exogenous enzyme are needed [37]. Other evidence suggested that efficacy of exogenous lactase was obtained from Kluyveromyces lactis , Aspergillus oryzae , or Kluyveromyces lactis [38, 39].…”

Lactose intolerance: what is a correct management?

“…41 When evaluating the effectiveness of supplementation with this enzyme, some authors found a reduction of expired hydrogen and improvement of LI symptoms. 42,43 However, the supplement is not capable of fully hydrolyzing the lactose, with different results in each individual. 15 There are reports on the association of lactase supplements and allergic reactions and anaphylaxis.…”