Extent of Lactose Absorption in Children with Active Celiac Disease

Use of the lactose H 2 breath test to monitor mucosal healing in coeliac disease

“…In one study of 34 affected children it was reported that lactose malabsorption was more common in those with severe villus atrophy, and it was also noted that most patients with lactose malabsorption were less than 3 y of age (8). Surprisingly, in another study using the lactose H 2 breath test, all 42 children with untreated coeliac disease had lactose malabsorption (10).…”

“…However, there is some disagreement in the published literature regarding the severity of lactase de ciency and the prevalence of lactose malabsorption in untreated coeliac disease (5)(6)(7)(8)(9)(10)(11)(12). There is also relatively little information available on the rate and extent of recovery from lactose malabsorption with gluten exclusion (22,24).…”

“…Several studies have shown that mucosal lactase activity is often reduced in the proximal intestine in untreated coeliac disease, and lactose malabsorption appears to be common (5)(6)(7)(8)(9)(10)(11)(12). The lactose H 2 breath test is a simple, inexpensive, non-invasive and sensitive technique for detecting lactose malabsorption (13)(14)(15).…”

Malabsorption of Carbohydrates

“…In older children evaluated for hypolactasia or sucrase malabsorption, breath hydrogen tests are simple to perform and sufficiently reliable. In contrast, the breath hydrogen test is not sufficiently discriminatory for use in the evaluation of secondary lactose absorption in suspected enteropathy, as the test outcome depends on too many variables [24], or in fructose absorption, as it is also positive in healthy children [25]. In any case, clinical symptoms following the sugar load should be evaluated as well, for breath hydrogen increase denominates malabsorption and not intolerance and thus may be irrelevant to the clinical condition of the child.…”

Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

“…Most children with newly diagnosed CD will tolerate ingestion of lactose, particularly in moderate amounts; therefore dietary lactose restriction is not usually necessary. Young children with more severe disease may benefit from a lactose-free diet initially (201).…”