Analysis of Lactose Intolerance in Students With Suggestive Symptoms of Irritable Bowel Syndrome

Abstract

BACKGROUND: Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE: The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS: In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS: Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION: In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.

The role of small intestinal bacterial overgrowth in food intolerances

“…Lactose intolerance was more common in women than in men. Moreover, attention was drawn to the higher frequency of gastrointestinal symptoms in women than in men, which may be influenced by the menstrual cycle, and more frequent occurrence of gastrointestinal diseases in women [25].…”

Diferenciação de diagnósticos e tratamentos entre alergia e intolerância ao leite

“…O hidrogênio resultante dessa fermentação entra na corrente sanguínea e é expirado pelo pulmão. É um exame que apresenta alta sensibilidade e especificidade, ajudando-o a ser o padrão para o diagnóstico da condição (Silva et al, 2019) O tratamento inicial deve ser a suspensão temporária do consumo de leite e seus derivados, porém a exclusão total do consumo de lactose deve ser evitada, pois os alimentos que a contém são fontes importantes de nutrientes e vitaminas, o que pode acarretar deficiência nutricional, sobretudo de cálcio. Se não houver uma melhora com a medida anterior, é necessário intervenção medicamentosa, como terapia de reposição da enzima lactase exógena e/ou utilização de probióticos (Mattar & Mazo, 2010).…”

Lactose Intolerance and Osteoporosis Development in Irritable Bowel Syndrome Patients

“…Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) health problem that is clinically characterized by some symptoms without an underlying disease (Torres et al, 2018). The pathophysiology of IBS has not clearly been defined, but a multifactorial mechanism is thought to be involved, including intestinal barrier disruption, intestinal motility alteration, microbiota disorder, immune system, visceral hypersensitivity, and changes in enteric nervous system/central nervous system interactions (McKenzie et al, 2012;Algera, Colomier, & Simrén, 2019;Silva et al, 2019;Wongtrakul, Charoenngam, & Ungprasert, 2020). In addition to these, it's thought that genetic factors, age, gender, diet, stress, some infections, and some drugs may be effective in the development of IBS (Chey, Kurlander, & Eswaran, 2015).…”

“…Diagnosis of IBS primarily requires the exclusion of some diseases such as colon cancer, celiac disease, inflammatory bowel disease, rectal bleeding/melena, and unexplained anemia (Chey et al, 2015). It's diagnosed using various diagnostic criteria developed specifically for IBS (Silva et al, 2019). Rome IV criteria are generally used as the current diagnostic standard.…”

“…•Decrease with defecation •Accompanied by changes in the frequency of defecation •Accompanied by a change in stool consistency IBS reduces the quality of life of patients by causing GI symptoms such as abdominal pain and discomfort, constipation or diarrhea, indigestion, flatulence and bloating, as well as fatigue, insomnia, and anxiety (Casellas et al, 2018;Silva et al, 2019;Chey, Keefer, Whelan, & Gibson, 2021). However, these symptoms aren't specific to IBS patients.…”