Prevalence of Lactose Malabsorption and Lactose Intolerance in Pediatric Patients with Selected Gastrointestinal Diseases

Abstract

Background. Lactase is an enzyme involved in the hydrolysis of lactose. Deficiency of the enzyme (hypolactasia) may be determined genetically or arise secondarily to disease of small intestine. Under this condition, lactose enters the colon where it is fermented by intestinal microflora and turns to gases and short-chain fatty acids, causing gastrointestinal symptoms known as lactose intolerance (LI). Objectives. To investigate the incidence of lactose malabsorption (LM), LI and the coexistence of these two conditions in children with upper gastrointestinal tract diseases (UGTD), malabsorption syndrome, inflammatory bowel disease (IBD) and functional gastrointestinal disorders (FGID). Material and Methods. Hydrogen breath test (HBT) was conducted in 387 pediatric patients in years 2010-2013. Two hundred thirty two children with gastrointestinal tract diseases were selected and assigned to groups -UGTD, malabsorption syndrome, IBD or FGID. For each group the frequency of LM, frequency and severity of LI and the frequency of their co-occurrence were calculated. Results. Lactose malabsorption was observed in 37.08% of patients with gastrointestinal diseases. Positive HBT result was the most common in children with malabsorption syndrome (52.50%) and less common in UGTD (30.85%), especially in ulcer disease (23.53%). Symptoms after lactose ingestion affected 36.64% of the subjects, and were more specific to lactose malabsorbers than to lactose absorbers (72.10% vs. 15.75%). The higher frequency of LI was noted in children with FGID, especially in irritable bowel syndrome (IBS) (65.22%). The lowest incidence of symptoms was obtained in children with UGTD, especially in those with ulcer disease (27.44%). The incidence of LM with LI was noted in 27.16% of all patients and was the highest in IBS (47.83%) and the lowest in ulcer disease (15.78%). Conclusions. Lactose malabsorption is a common problem in children with gastrointestinal diseases, especially in children with bowel diseases. Lactose intolerance is related to LM, but does not affect all malabsorbers (Adv Clin Exp Med 2015, 24, 5, 863-871).

Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

“…Carbohydrate malabsorption was frequently associated with FAPD in our cohort whereas a higher occurrence of lactose malabsorption, of which 37% of cases were detected by H 2 BT (cut off ≥ 20 ppm), has already been reported in children with both organic and functional gastrointestinal diseases [43]. The highest symptomatic lactose intolerance ratio was found among children with irritable bowel syndrome (47.8%) in that study [43]. Moreover, adult IBS patients with predominant abdominal pain benefit from fructose-restricted diets measured by a visual analogue scale independent from the results of fructose H 2 BT [44].…”

“…Making the diagnosis of FAPD or carbohydrate intolerance can be a challenge, as reliable biomarkers are missing and diagnostic tests have their limitations; therefore, a structured diagnostic algorithm for CAP is mandatory [13,19,43,47,48]. In order to select patients with FAPD for an interventional trial, we established a detailed diagnostic program based on current evidence, guidelines, and clinical practice.…”

“…In our study, the majority of abnormal H 2 BT results (76% for lactose and 82% for fructose) had no clinical relevance, as CAP persisted after elimination of the respective carbohydrate. Indeed, H 2 BT is not sufficient to ensure and verify carbohydrate intolerance in children with CAP [21,43,49]. Thus, the diagnosis of fructose or lactose intolerance should be verified by symptoms during H 2 BT, elimination diet, open provocation, and further diagnostic workup, respectively [21,29,43].…”

“…Indeed, H 2 BT is not sufficient to ensure and verify carbohydrate intolerance in children with CAP [21,43,49]. Thus, the diagnosis of fructose or lactose intolerance should be verified by symptoms during H 2 BT, elimination diet, open provocation, and further diagnostic workup, respectively [21,29,43]. Thereby, carbohydrate malabsorption diagnosed by an abnormal H 2 BT could be separated from clinically significant intolerance or visceral hypersensitivity hampering everyday life.…”

In Situ Random Microseeding and Streak Seeding Used for Growth of Crystals of Cold-Adapted β-d-Galactosidases: Crystal Structure of βDG from Arthrobacter sp. 32cB

“…Enzymatically hydrolyzed lactose, especially in milk, whey, or whey derivatives, is broadly used due to its higher sweetness, which ameliorates product taste, and to application in specialized food production, for people with lactose malabsorption [1][2][3]. Administration of products with depleted levels of lactose and other digestible oligosaccharides, disaccharides, monosaccharides, and polyols instead of common food is beneficial in the prevention of irritable bowel syndrome (IBS) [4][5][6][7][8][9]. Cold-active β-D-galactosidases (βDGs) have become a focus of attention because of their ability to eliminate lactose from refrigerated milk, convert lactose to glucose and galactose (decreasing its hygroscopicity), and eliminate lactose from dairy industry pollutants associated with environmental problems.…”