Lactose intolerance, detected by the hydrogen breath test, in infants and children with chronic diarrhoea

Abstract

SUMMARY Twenty-three infants and children aged 21 months to 13 years with chronic diarrhoea and 6 patients without diarrhoea were investigated for lactose malabsorption with the hydrogen breath test (HBT) adapted for use in young infants and children. A further 8 children with proven or suspected coeliac disease were also investigated. The HBT was compared with the histology of the jejunal mucosa, mucosal lactase estimations, a lactose tolerance test, symptoms during the test, and follow-up after starting a lactose free diet.The 6 patients without diarrhoea showed no evidence of hypolactasia and the hydrogen (H2)* concentration on the HBT was below 7 parts per million (ppm), a level considered to be clinically nonsignificant. 12 of the 23 patients with diarrhoea had a breath H2 concentration greater than 24 ppm and this correlated well with their clinical symptoms during or after the test and with the remission of the diarrhoea after lactose withdrawal. Of the remaining 11 patients with diarrhoea whose breath H2 concentration was lower than 25 ppm, symptoms did not improve when a lactosefree diet was started in 3, while a further 4 improved on a full diet.There was poor correlation between the HBT and the findings on the jejunal mucosal specimens. All but one of the coeliac patients had an HBT less than 20 ppm and none of these required lactose withdrawal for remission of symptoms. The HBT is a noninvasive test particularly suitable for outpatients and it gives a useful prognostic guide to the efficacy of lactose-free diet in the treatment of chronic diarrhoea in children.

Hydrogen: From a Biologically Inert Gas to a Unique Antioxidant

“…Additionally, there is evidence of endogenous hydrogen in human and animals from anaerobic metabolism of bacteria in the large intestine (Sobko et al, 2005). In the normal terminal breath, levels of H 2 are in the range 5-10 ppm (Maffel et al, 1977) ; in the liver, it reaches 42 μM, while in the large intestine and spleen, it is even higher (Olson & Maier, 2002) . The existence of endogenous hydrogen also suggests that hydrogen may be capable of exerting biological effects in physiological and pathological conditions in a manner similar to NO, CO and H 2 S. However, much additional research is required prior to verification, such as characterizing the molecular mechanism of hydrogen's effects.…”

“…It is noteworthy that endogenous hydrogen exists in humans and animals from anaerobic metabolism of bacteria in the large intestine (Maffel et al, 1977). Studies have shown that the hydrogen level in normal terminal breath is about 5-10 ppm, but in patients with lactose intolerance and bacterial disorders, it may achieve more than 90 ppm (Olson et al, 2002).…”

Lactase Deficiency and Lactose Malabsorption

“…The test is positive if breath hydrogen rises by more than 20 ppm 2 h after ingestion of 50 g lactose [30,36,43], The test is noninvasive, easy to use and highly sensitive and specific for lactase deficiency [36]. It can be used in children as well as adults [44] and is particularly valuable for the study of large numbers of individuals. Bacterial over growth of the small intestine may cause false-positive results and is suspected if basal breath hydrogen values are high.…”

Distributions and Incidences of Elementary School Children with Lactose Intolerance Symptoms after Drinking Milk in Korea

“…In Europe, 2% in Northern Europe and Scandinavia, -70% in Italy and Sicily were reported to be lactose intolerant, showing significant difference across geographical locations. Many methods have been developed to diagnose lactose intolerance in an objective and scientific way, none is perfect but the hydrogen breath test (or breath hydrogen test), has been the current method of choice in many countries (Maffei et al, 1977). This study was conducted to obtain basic information about distributions and incidence of lactose maldigestion or lactose intolerance symptoms for elementary school children in Korea.…”

“…Once lactose is absorbed in mucosa of small intestine, it is then in turn utilized to synthesize nondigestible galactooligosaccharides which promote growth of few probiotic bacteria and to improve gut microbiota by inhibiting the growth of harmful organisms in the intestine, promoting digestion and improving the health of the body. Lactose intolerance is clinically diagnosed with the breath hydrogen production test as well as intestinal biopsy in clinical practice (Maffei et al, 1977). About 75% of the world's population genetically lacks innate ability to digest lactose.…”