Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance

Jellema, Petra; Schellevis, F.G.; Windt, D.A.W.M. van der; Kneepkens, C. M. F.; Horst, H.E. van der

doi:10.1093/qjmed/hcq082

Cited by 94 publications

(93 citation statements)

References 36 publications

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“…Ebben segíthetnek a kérdőívek. Kontrollált tanulmányokban észlelték, hogy a típusos tü-netek alapján az LI az esetek 80%-ában biztonsággal kór-ismézhető [27,28].…”

Section: Noninvazív Módszerekunclassified

A laktózintoleranciáról: Múlt és jelen – I. rész

Buzás¹

2015

Orvosi Hetilap

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A tejcukor-érzékenység a leggyakoribb felszívódási zavar. A szerző a betegség történetének ismertetése után leírja a laktózintolerancia megjelenését a fajfejlődés során, majd vázolja a laktóz biokémiai jellegzetességeit. Az emberi és bakteriális laktáz enzim tulajdonságainak ismertetése után az epidemiológiai részben kitér a kórkép egyenlőtlen föld-rajzi eloszlására, régebbi és jelenlegi hazai elterjedésére. A felnőttkori laktózintoleranciát a 2. kromoszómán található laktáz gén felett elhelyezkedő MCM6 gén polimorfi zmusa okozza: meghatározása polimeráz láncreakcióval lehetsé-ges. A tejcukor-érzékenység extraintestinalis tünetei kevésbé ismertek. Az invazív diagnosztikai módszerek (laktázak-tivitás mérése vékonybél-biopsziából, laktóztolerancia-teszt) bár pontosak, átadták helyüket a nem invazív módsze-reknek: a H 2 -kilégzési teszt arany strandardnak számít. A genetikai tesztet egyre kiterjedtebben használják hazánkban is, és a közeljövőben a metánkilégzési teszt is elérhető lehet. A tejcukor-érzékenység társulhat gyulladásos bélbeteg-ségekkel, lisztérzékenységgel és irritábilis bél szindrómával: meg kell állapítani, hogy létezik-e patogenetikai összefüg-gés e betegségek között a helyes diéta és terápia megválasztása céljából. Orv. Hetil., 2015, 156(38), 1532-1539.Kulcsszavak: coeliakia, gyulladásos bélbetegség, irritábilis bél, laktáz, laktóz, polimorfi zmus, tejcukor-érzékenység Lactose intolerance: past and present. Part I Lactose intolerance is the most prevalent intestinal malabsorption disorder. After presentation of its history, the author describes the emergence of lactose intolerance during the evolution of species, and the biochemistry of lactose as well as features of human and bacterial lactase enzymes are then described. The unequal distribution of lactose intolerance in different continents and population is discussed, followed by presentation of past and present prevalence data in Hungary. Adult-type hypolactasia is caused by a polymorphism of the MCM6 gene located upstream from the lactase gene on the long arm of the chromosome 2. It can be determined with the polymerase chain reaction. The intestinal symptoms of lactose intolerance are well known, but its extra-intestinal manifestations are less recognised. Invasive diagnostic methods (determination of lactase activity from small intestinal biopsies, lactose tolerance test), are accurate, but have been replaced by the non-invasive methods; their gold standard is the H 2 breath test. Genetic testing is being used more and more frequently in Hungary too, and, presumably, the methane breath test will be also available in the near future. Lactose intolerance can be accompanied by infl ammatory bowel diseases, coeliac disease and irritable bowel syndrome; it could be established whether this association is causal or not in order to start a correct diet and therapy. Rövidítések A = adenin; BL = bakteriális laktáz; C = citozin; CD = Crohnbetegség; CU = colitis ulcerosa; EC = (enzyme classifi cation) az enzimek osztályozása; G = guanin; IBD = gyulladá...

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“…Ebben segíthetnek a kérdőívek. Kontrollált tanulmányokban észlelték, hogy a típusos tü-netek alapján az LI az esetek 80%-ában biztonsággal kór-ismézhető [27,28].…”

Section: Noninvazív Módszerekunclassified

A laktózintoleranciáról: Múlt és jelen – I. rész

Buzás¹

2015

Orvosi Hetilap

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“…7 The symptoms of lactose intolerance result from bacterial fermentation of undigested lactose in the colon. Lactose intolerance can be diagnosed by having individuals ingest a standard dose of lactose after fasting and finding elevated levels of breath hydrogen which is produced by bacterial fermentation of undigested lactose in the colon.…”

Section: Diagnosing Lactose Intolerancementioning

confidence: 99%

“…Lactose intolerance can be diagnosed by having individuals ingest a standard dose of lactose after fasting and finding elevated levels of breath hydrogen which is produced by bacterial fermentation of undigested lactose in the colon. 4 A recent systematic review by Jellema et al 7 found that the diagnostic performance of reported symptoms that are associated with lactose intolerance (diarrhoea, abdominal pain, bloating and flatulence) was highly variable. More firm associations were found for ethnicity.…”

Section: Diagnosing Lactose Intolerancementioning

confidence: 99%

“…Overall, symptoms were more often associated with lactose malabsorption than absorption. 7 The LHBT is currently considered to be the diagnostic method of choice, but it actually identifies lactose malabsorption, rather than lactose intolerance. Formerly, the usual test dose was 50 g. However, a 25 g dose is standard S Afr Fam Pract 2012 in clinical practice and has recently been confirmed as the recommended dosage.…”

Section: Diagnosing Lactose Intolerancementioning

confidence: 99%

“…4,7 There is considerable confusion about the terms "lactose intolerance" and "milk allergy". Reported reactions to foods are often believed to be manifestations of a food allergy.…”

Section: Lactose Intolerance and Healthmentioning

confidence: 99%

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Understanding lactose intolerance and the dietary management thereof

Labuschagne

Lombard

2012

South African Family Practice

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Lactose intolerance is not the cause of gastrointestinal adverse effects in beta thalassemia patients treated with deferasirox

Pazgal¹,

Brown

Perets

et al. 2014

American J Hematol

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receive cytotoxic chemotherapy prior to HSCT. After organ function improvement, patients were able to proceed to HSCT. We also used sorafenib in patients whose leukemia with FLT3-ITD relapsed after HSCT and observed meaningful clinical outcomes in this extremely poor prognostic situation. Metzelder et al. demonstrated high activity of sorafenib in FLT3-ITD AML post-HSCT possibly secondary to synergizing allo-immune effects leading to sustained regression in this specific population [9]. We also used sorafenib as maintenance therapy pre-and post-HSCT with durable complete response. Sorafenib was tolerated well with occasional dose reductions due to adverse events including elevated liver enzymes. Further prospective clinical trials are needed to evaluate the use of sorafenib in FLT3-ITD AML as single and/or adjunctive therapy.

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Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance

Abstract: Our review shows that high-quality studies on the diagnosis of lactose malabsorption and intolerance in primary care are urgently needed. An important prerequisite would be to clearly define the concept of lactose intolerance, as well as how it should be assessed.

Cited by 94 publications

References 36 publications

A laktózintoleranciáról: Múlt és jelen – I. rész

A laktózintoleranciáról: Múlt és jelen – I. rész

Understanding lactose intolerance and the dietary management thereof

Lactose intolerance is not the cause of gastrointestinal adverse effects in beta thalassemia patients treated with deferasirox

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