Hydrogen excretion in pediatric lactose malabsorbers: relation to symptoms and the dose of lactose

Abstract

IntroductionLactose malabsorption arises from lactase deficiency and may lead to lactose intolerance – gastrointestinal symptoms after lactose ingestion. Occurrence and severity of the symptoms are influenced by many factors, including the dose of lactose and the intensity of its colonic fermentation to short chain fatty acids and gases.Material and methodsThe hydrogen breath test (HBT) after 30 g or 50 g of lactose was performed in 387 children. Further analysis included children who had a positive HBT result. The HBT parameters were net hydrogen concentration in each breath and total net hydrogen concentration during the HBT. The time of the first hydrogen rise was also calculated. HBT parameters were analyzed according to symptoms occurrence (lack or present), symptoms severity (lack, moderate or severe) and the dose of lactose (30 g or 50 g).ResultsOne hundred and six children (12.1 years, 46 boys) had a positive HBT result. Symptoms occurrence was positively related to net hydrogen concentration at 30 min, 60 min and 90 min (p < 0.001 at each time point), as well as to the total net hydrogen concentration (p < 0.001). There were no differences in hydrogen excretion between subjects with moderate and severe symptoms after lactose ingestion. Symptoms were more frequent in subjects given 50 g of lactose than in those given 30 g of lactose (79% vs. 47%, p = 0.003). In both dose groups symptoms occurrence was related to hydrogen excretion.ConclusionsSymptoms occurrence is closely related to hydrogen excretion and to the dose of ingested lactose.

Comparing Response of Sheep and Cow Milk on Acute Digestive Comfort and Lactose Malabsorption: A Randomized Controlled Trial in Female Dairy Avoiders

“…The complex interaction of all these factors precludes calculation of compensatory adjustment of breath H 2 . The adjustment of breath H 2 concentrations for specific substrates or doses is not a standardized practice ( 42 ), and given that lactose dosing may even require adjustment for body weight ( 61 ), may not be a straightforward calculation. Although the current study showed lower lactose malabsorption with SM, differences in lactose digestion following SM should be investigated within the upper range of lactose content naturally occurring in SM, which may be more closely matched to CM.…”

Intestinal bacterial overgrowth in the early stage of severe acute pancreatitis is associated with acute respiratory distress syndrome

“…Since the production of methane requires hydrogen metabolism, the hydrogen and methane concentrations can be simultaneously detected with the carbohydrate breath test. The lactulose hydrogen respiration test involves oral lactulose (non-absorbent sugar) to the cecum, fermentation with coliform bacteria to produce hydrogen and methane, absorption into the systemic circulation, and then exhalation to detect the concentration of hydrogen/methane in the breath; when the concentration of hydrogen/methane in the breath exceeds the baseline, a SIBO diagnosis can be reached[ 11 ].…”

Development and validation of the paediatric Carbohydrate Perception Questionnaire (pCPQ), an instrument for the assessment of carbohydrate‐induced gastrointestinal symptoms in the paediatric population

“…16 A wide array of abdominal symptoms, such as abdominal pain, cramping, bloating, distention, nausea, flatulence, and loose stools or diarrhea, has been considered relevant symptoms in children and adolescents. 11,12,15 Here, we describe the development and validation of a self-administered symptom measurement questionnaire to assess the severity and the type of abdominal symptoms after the ingestion of a carbohydrate load in the pediatric population, the paediatric Carbohydrate Perception Questionnaire (pCPQ). A preliminary validation of this instrument has been reported elsewhere.…”

“…In the pediatric literature, the difficulty in data interpretation due to a lack of a validated symptom assessment tool has been acknowledged 11 . Symptoms following a carbohydrate challenge have been assessed by inviting the patient and/or their caregivers to report any undesignated symptom as it may arise, 12‐14 by recall of specific symptoms, 15 or by use of a generic pain questionnaire 13 or a questionnaire that was not validated for the pediatric population 16 . A wide array of abdominal symptoms, such as abdominal pain, cramping, bloating, distention, nausea, flatulence, and loose stools or diarrhea, has been considered relevant symptoms in children and adolescents 11,12,15 …”