Irritable bowel syndrome: is the search for lactose intolerance justified?

Parker, Tracy; Woolner, J. T.; Prevost, A. Toby; Tuffnell, Q.; Shorthouse, M.; Hunter, John

doi:10.1097/00042737-200103000-00001

Cited by 103 publications

(93 citation statements)

References 29 publications

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“…[9] There is little advantage in trying to separate patients who malabsorb lactose from those with IBS. [20] Although LI symptoms were more common in IBS patients, in the absence of documented lactose malabsorption, we cannot be certain that the reported symptoms indeed are those of LI or simply those of IBS. So, a period of dairy product avoidance and/ or a test for lactose malabsorption may be beneficial in these patients. )…”

Section: Discussionmentioning

confidence: 88%

“…[19] The most likely explanation is hypersensitivity to the gut distension due to hydrogen gas produced by bacterial fermentation of unabsorbed lactose. [20,21] Another explanation may be a placebo effect. IBS patients probably look for association between food and symptoms and are aware of the association between lactose ingestion and symptoms of bloating, ß atulence and diarrhea.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

Saberifiroozi¹,

Khademolhosseini²,

Mehrabani³

et al. 2007

Indian J Med Sci

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

Saberifiroozi¹,

Khademolhosseini²,

Mehrabani³

et al. 2007

Indian J Med Sci

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“…The study by Ledochowski et al [24] , which has shown that dietary changes in patients with fructose malabsorption have a beneficial effect on gastrointestinal complaints and also on mood, as documented by improvements in depression score, has already been mentioned above. However, there are also contradictory data that show that only avoiding one sugar (with proven malabsorption) may not be sufficient for patients with irritable bowel syndrome [43,44] . The phenomenon that patients with non-specific abdominal complaints frequently report improvement in their symptoms for several weeks after colonoscopy (thought to be due to bowel preparation with cleansing of the colon) underlines the possible role of bacteria in the colon.…”

Section: Therapymentioning

confidence: 99%

Carbohydrate malabsorption in patients with non-specific abdominal complaints

Born¹

2007

WJG

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Non-specific abdominal complaints are a considerable problem worldwide. Many patients are affected and many differential diagnoses have to be considered. Among these, carbohydrate malabsorption seems to play an important role. However, so far, only incomplete absorption of lactose is broadly accepted, while the malabsorption of fructose and sorbitol is still underestimated, although in many parts of the world it is much more frequent. Despite the success of dietary interventions in many patients, there are still a lot of unanswered questions that make further investigations necessary.

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“…We excluded, in our study, pts with a diagnosis of SIBO because it is well described in the literature [18] that during bacterial overgrowth, subjects may have lactose intolerance not by enzyme deficiency but to premature exposure of lactose to bacteria in the small bowel before there is time for a correct absorption [19][20][21][22]. This was further validated by Nucera et al, who demonstrated in 98 subjects with IBS that small intestinal bacterial overgrowth eradication, as confirmed by negative lactulose breath test, caused a significant reduction in lactose breath test positivity [23].…”

Section: Discussionmentioning

confidence: 99%

Early peak of hydrogen during lactose breath test predicts intestinal motility

Ojetti¹,

Rienzo²,

D’Angelo³

et al. 2014

OJGas

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Lactose breath test (LBT) is considered the gold standard for the diagnosis of lactose malabsorption.The test is considered positive for a peak of hydrogen (H 2 ) ≥ 20 parts per million (ppm) above the baseline. Some patients (pts) showed a rapid peak between 30 and 90 minutes after lactose ingestion. The aim of this study was to evaluate the predictive value of an early peak during a LBT and an accelerated oro-cecal transit time (OCTT). We retrospectively analyzed all pts who referred to our Gastroenterology unit for Irritable Bowel Syndrome, from January to September 2012, who performed LBT, glucose and lactulose breath test. We consider a positive LBT for a peak of H 2 > 20 ppm, a positive GHBT for a peak >12 ppm and we considered a normal OCCT a peak of H 2 ≥ 10 ppm between 75 ± 105 min after lactulose load. The correlation between LBT and OCTT was evaluated by Pearson score. 93 pts (65 F/28 M mean age 47 ± 6 years) with a positive LBT, without small intestinal bacterial overgrowth were analyzed: 46 pts (32 F/14 M; mean age 48 ± 6 years) with an early peak (<90 min) of H 2 (≥20 ppm) were enrolled as case, and 47 pts matched for sex and age with a peak of H 2 after 90 min were enrolled as controls. 72% (33/46) of the group with an early peak showed an accelerated, 17% (8/46) a normal and 11% (5/46) a delayed OCTT. Meanwhile, in control group 40.4% (19/47) showed a normal, 57.5% (27/47) a delayed and just 1 pts an accelerated OCTT. The specificity and sensibility of LBT for an accelerated OCTT were 97.9% and 71.7% respectively. The positive predictive value of LBT for an accelerated OCTT is 97.1%; the negative predictive value is 78%. There is a significant correlation between LBT and OCTT (p < 0.05). The presence of an early peak of H 2 between 30 and 90 min after the ingestion of 25 gr of lactose could predict the presence of an accelerated OCTT in 97% of pts. If confirmed by further study, in this subset of pts, lactulose breath test for evaluating OCTT could be avoided.

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Irritable bowel syndrome: is the search for lactose intolerance justified?

Cited by 103 publications

References 29 publications

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

Carbohydrate malabsorption in patients with non-specific abdominal complaints

Early peak of hydrogen during lactose breath test predicts intestinal motility

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