High Prevalence of Celiac Disease in Patients with Lactose Intolerance

Abstract

Background/Aims: Acquired lactase deficiency is a common cause of gastrointestinal symptoms but its etiology remains unclear. Celiac disease could lead to lactase deficiency and is much more common than previously suspected. Several studies have highlighted the prevalence of lactose intolerance in celiac disease, but studies assessing the prevalence of celiac disease in lactose intolerance are lacking. We evaluated the prevalence of celiac disease in patients with a positive H₂-lactose breath test compared to a control group. Methods: This retrospective study included 54 patients (15 males/39 females; mean age 37.8 ± 7 years) from southern Italy, referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of milk or dietary lactose. They had a positive H₂-lactose breath test and a negative H₂-glucose breath test. 50 blood donors were drawn from a similar population, matched for sex and age, and enrolled as a control group. All patients were screened for possible celiac disease by measuring the serum level of IgA antibodies to endomysium, anti-transglutaminase and total IgA. Patients positive for at least one of these markers were submitted to upper gastrointestinal endoscopy. Results: None of the patients had a IgA deficiency. 24% of the patients showed positivity of celiac disease antibodies compared to 2% in the control group (p < 0.001). Histologic samples of these patients showed villous atrophy (53.8% Marsh type IIIa, 38.4% Marsh IIIb, and 7.6% with Marsh type IIIc) confirming the celiac disease, while in the control subjects duodenal biopsies were normal. Conclusions: A high prevalence of celiac disease was observed in patients with a positive H₂-lactose breath test compared to healthy controls. In these subjects lactase deficiency seems to be the only manifestation of celiac disease. We suggest serologic screening for celiac disease in all patients with a positive H₂-lactose breath test before beginning a milk-exclusion diet.

Quantifying the ‘hidden’ lactose in drugs used for the treatment of gastrointestinal conditions

“…Serologic screening for coeliac disease in all patients with a positive H2-lactose breath test should be carried out before beginning a milk-exclusion diet. 39 Lactose intolerance in IBD was thought to be a cofactor that predisposed to a clinical attack or it is a consequence or accompanying phenomenon of the disease. Several studies have shown variable prevalence of LI in IBD.…”

Metabolic and Nutritional Features in Adult Celiac Patients

“…A possible daily caloric impairment could thus take place. Recently it has been shown that lactase deficiency seems to be the only manifestation of CD [21] .…”

Häufige Ursachen von Durchfall: Sprue und Lactoseintoleranz

“…Bei Patienten mit Sprue kommt es durch die geschä-digte Dünndarmschleimhaut gehäuft auch zu einer sekundären Lactoseintoleranz [11,12]. Andererseits findet sich offenbar bei Patienten mit Lactoseintoleranz eine erhöhte Prädisposition für die Ausbildung einer Sprue [2].…”

“…Unter Berücksichtigung der Ätiologie lässt sich der Lactasemangel weiter unterteilen, wobei die Klassifikation bei verschiedenen Autoren nicht immer einheitlich ist [2,24]. Übereinstimmend wird die primäre (z.B.…”

“…Etwa 70% der Weltbevölkerung sind in unterschiedlicher Ausprägung und in verschiedenem Alter von der Störung betroffen. In der weißen Bevölkerung treten erste Symptome bei Kindern in der Regel nicht vor einem Alter von 4-5 Jahren auf, während ein großer Teil der Kinder mit einem anderen ethnischen Hintergrund auch früher symptomatisch werden kann [2,24]. Pathogenetisch konnten verschiedene Polymorphismen in der DNA-Sequenz der kodierenden und regulierenden Region des Lactasegens identifiziert werden.…”