ObjectivesLactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H2B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H2B concentrations.MethodsA total of 430 patients (40 years, Q1–Q3 = 28–54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively.ResultsH2B was <10 ppm in 69.5% of subjects; 10–20 ppm in 14.7%; and >20 ppm in 15.8% of subjects. In patients with H2B <20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=−0.389; p<0.05). The increase in glycemia during LTT was not influenced by H2B levels obtained in HBT.ConclusionsLTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H2B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.
Predictive value of hyperglycosylated human chorionic gonadotropin for pregnancy outcomes in threatened abortion in first-trimester viable pregnanciesValor predictivo de la hCG hiperglosilada para predecir resultado de la gestación en amenaza de aborto de primer trimestre en gestación viable
ResumenObjetivosLa malabsorción de lactosa se estudia habitualmente mediante el test de hidrógeno espirado (HBT), aunque su realización no es recomendable cuando la concentración de hidrógeno basal (H2B) es elevada. Además, la situación actual en relación con el SARS-CoV-2 puede hacer desaconsejable el manejo de muestras de aliento. Objetivo: Evaluar la concordancia del HBT y el test de tolerancia a la lactosa (TTL) en función del H2B.MétodosSe estudiaron 430 pacientes (40 años, Q1–Q3 = 28–54 años; 66,7% mujeres) con sospecha de malabsorción de lactosa. Se recogieron basalmente y secuencialmente tras la administración de lactosa, muestras de aliento para medir el hidrógeno espirado y de sangre heparinizada para medir la glucemia.ResultadosEl 69,5% de los pacientes tenían H2B <10 ppm, el 14,7% valores entre 10 y 20 ppm, y el 15,8% >20 ppm. En los pacientes con H2B <20 ppm la concordancia entre el HBT y el TTL era moderada, mejorando siempre al emplear un punto de corte de 15 mg/dL en el TTL. El incremento de hidrógeno y el de glucosa correlacionaron negativamente (r=−0,389; p<0,05). El aumento observado en la glucemia durante el TTL no variaba en función de los niveles de H2B registrados en el HBT.ConclusiónesEl TTL puede ser una alternativa al HBT para evaluar la malabsorción de lactosa cuando los niveles de H2B sean elevados o las circunstancias desaconsejen el manejo de muestras de aliento. La mejor concordancia se observa cuando se toma como punto de corte en el TTL de 15 mg/dL.
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