Abdominal Pain Associated with Lactose Ingestion in Children with Lactose Intolerance

Gremse, David A.; Greer, A Scott; Vacik, Jonathan; DiPalma, Jack A.

doi:10.1177/000992280304200406

Cited by 35 publications

(26 citation statements)

References 16 publications

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“…The treatment of lactose intolerance, based on removing milk products from the diet, usually improves the symptoms, but the diet needs to be continued long enough to clearly evaluate whether the symptoms resolve or not [28]. If there is any doubt about improvement after the diet, particularly if symptoms normally fluctuate in intensity over weeks or months, repeated periods of lactose elimination should be tried until a firm conclusion can be drawn.…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, our study suggests that in patients suffering from lactose intolerance, a screening for CD should be performed and, when serology and endoscopic diagnostic findings are positive for gluten intolerance, an appropriate gluten-free diet should be promptly established in order to avoid the potential complications of CD [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

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High Prevalence of Celiac Disease in Patients with Lactose Intolerance

et al. 2005

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Background/Aims: Acquired lactase deficiency is a common cause of gastrointestinal symptoms but its etiology remains unclear. Celiac disease could lead to lactase deficiency and is much more common than previously suspected. Several studies have highlighted the prevalence of lactose intolerance in celiac disease, but studies assessing the prevalence of celiac disease in lactose intolerance are lacking. We evaluated the prevalence of celiac disease in patients with a positive H₂-lactose breath test compared to a control group. Methods: This retrospective study included 54 patients (15 males/39 females; mean age 37.8 ± 7 years) from southern Italy, referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of milk or dietary lactose. They had a positive H₂-lactose breath test and a negative H₂-glucose breath test. 50 blood donors were drawn from a similar population, matched for sex and age, and enrolled as a control group. All patients were screened for possible celiac disease by measuring the serum level of IgA antibodies to endomysium, anti-transglutaminase and total IgA. Patients positive for at least one of these markers were submitted to upper gastrointestinal endoscopy. Results: None of the patients had a IgA deficiency. 24% of the patients showed positivity of celiac disease antibodies compared to 2% in the control group (p < 0.001). Histologic samples of these patients showed villous atrophy (53.8% Marsh type IIIa, 38.4% Marsh IIIb, and 7.6% with Marsh type IIIc) confirming the celiac disease, while in the control subjects duodenal biopsies were normal. Conclusions: A high prevalence of celiac disease was observed in patients with a positive H₂-lactose breath test compared to healthy controls. In these subjects lactase deficiency seems to be the only manifestation of celiac disease. We suggest serologic screening for celiac disease in all patients with a positive H₂-lactose breath test before beginning a milk-exclusion diet.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High Prevalence of Celiac Disease in Patients with Lactose Intolerance

et al. 2005

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“…One trial identified worsening abdominal pain (but not other symptoms) in children with AP-FGIDs with lactose malabsorption when using nonhydrolyzed lactose milk versus hydrolyzed lactose milk [21] . However, the other two trials did not find that lactose significantly worsened symptoms in children with AP-FGIDs and lactose malabsorption [20, 22].…”

Section: Carbohydrate Intolerancementioning

confidence: 99%

Dietary Carbohydrates and Childhood Functional Abdominal Pain

Chumpitazi

Shulman²

2016

Ann Nutr Metab

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Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.

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“…As little as 12 g of lactose (the amount of lactose in an 8-oz glass of milk) may be sufficient to cause symptoms in children with chronic abdominal pain. 31 In addition, unabsorbed lactose is a substrate for intestinal bacteria, especially in the colon. Bacteria metabolize lactose, producing volatile fatty acids and gases (methane, carbon dioxide, and hydrogen), leading to flatulence.…”

Section: Diagnosismentioning

confidence: 99%

Lactose Intolerance in Infants, Children, and Adolescents

Heyman¹

2006

Pediatrics

441

341

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The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided. INTRODUCTIONSIGNIFICANT CHANGES IN our knowledge and approach toward lactose intolerance have occurred over the past quarter century, since the first statement on lactose intolerance was published by the American Academy of Pediatrics Committee on Nutrition. 1 Lactose ingestion in certain susceptible individuals can cause abdominal symptoms that are variable and can be treated with dietary restriction or enzyme replacement, depending on the amount of lactose consumed and the degree of lactase deficiency. Pediatricians and other pediatric care providers should maintain awareness of the benefits and controversies related to the consumption of dietary milk products and milk-based infant formula. The lactose content of milk often influences, correctly or not, the ultimate decision about the use or continuation of milk in the diet. Milk and dairy-product avoidance has a negative effect on calcium and vitamin D intake in infants, children, and adolescents. Other nutrients such as protein make dairy products an important source of nutrition for growing children. This revised statement will update the initial statement of 1978 while incorporating changes from the 1990 supplement 2 and current state-of-theart relating to lactose intolerance. Recommendations regarding dietary calcium have been updated recently. 3 Lactose, a disaccharide that comprises the monosaccharides glucose and galactose, is the primary carbohydrate found exclusively in mammalian milk. Absorption of lactose requires lactase activity in the small intestinal brush border to split the bond linking the 2 monosaccharides. A ␤-galactosidase termed "lactase-phlorizin hydrolase" (lactase) accounts for most of the lactase activity in the intestinal

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Abdominal Pain Associated with Lactose Ingestion in Children with Lactose Intolerance

Cited by 35 publications

References 16 publications

High Prevalence of Celiac Disease in Patients with Lactose Intolerance

High Prevalence of Celiac Disease in Patients with Lactose Intolerance

Dietary Carbohydrates and Childhood Functional Abdominal Pain

Lactose Intolerance in Infants, Children, and Adolescents

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