Lactose Intolerance Assessed by Analysis of Genetic Polymorphism, Breath Test and Symptoms in Patients with Inflammatory Bowel Disease

Abstract

Many patients with inflammatory bowel disease (IBD) restrict dairy products to control their symptoms. The aim of the study was to investigate the prevalence of lactose intolerance assessed with hydrogen breath test (H-BT) in IBD patients in clinical remission compared to a sex, age and BMI matched control population. We further detected the prevalence of three single nucleotide polymorphisms of the lactase (LCT) gene: the lactase non persistence LCT-13910 CC (wildtype) and the intermediate phenotype LCT-22018 CT and LCT-13910 AG; finally, we assess the correlation between genotype and H-BT. A total of 54 IBD patients and 69 control who underwent clinical evaluation, H-BT and genetic test were enrolled. H-BT was positive in 64.8% IBD patients and 62.3% control (p = 0.3). The wild-type genotype was found in 85.2% IBD patients while CT-22018, AG-13910 and CT-22018/AG-13910 polymorphisms were found in 9.3%, 1.8% and 3.7%. In the control group, the wild-type genotype, CT-22018, AG-13910 and CT-22018/AG-13910 polymorphisms were found in 87%, 5.8%, 5.8% and 1.4% of cases, respectively. Therefore, the wild-type and polymorphisms’ prevalence did not differ between IBD population and control group (85.2% vs. 87%, p = 0.1) (14.8% vs. 13%, p = 0.7). The correlation between positive H-BT and genetic analysis showed that the wild-type genotype was associated with higher rate of lactose intolerance in the total population (OR 5.31, 95%CI 1.73–16.29, p = 0.003) and in the IBD (OR 7.61, 95%CI 1.36–42.7, p = 0.02). The prevalence of lactose intolerance in IBD patients did not differ from that of control. Despite suggestive symptoms, about 1/3 of IBD patients are not lactose intolerant, thus not needing “a priori” elimination diet. This may encourage a rationale and balanced dietary management in IBD.

Lactose Malabsorption and Presumed Related Disorders: A Review of Current Evidence

“…In addition, the outcome of the meta-analysis suggests that hypolactasic (primary LM) and normolactasic persons may be equally affected by IBD. According to several studies, the prevalence of primary LM in IBD patients does not differ from that of controls [ 30 ].…”

“…On the other hand, an overall prevalence of 35% of patients with IBD experiences digestive symptoms despite clinical remission [ 30 ]. Apart from irritable bowel disease (IBS), LM can account in part for persistent digestive symptoms in IBD patients on clinical remission.…”

Selected Aspects of Nutrition in the Prevention and Treatment of Inflammatory Bowel Disease

“…However, it is noted in the literature that milk sugar intolerance assessed by breath test and analysis of genetic polymorphism among healthy controls is comparable to the group of IBD patients. Therefore, there is no need to routinely eliminate lactose from the patients’ diet, unless required by the patient’s specific dietary intervention, e.g., CDED [ 116 ].…”

“… Dietary interventions included in the article that are applicable or potentially applicable in inflammatory bowel disease in specific clinical situations [ 21 , 22 , 43 , 72 , 73 , 74 , 75 , 76 , 77 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 99 , 100 , 101 , 104 , 106 , 111 , 112 , 113 , 116 , 117 ]. …”

Exclusive Enteral Nutrition in Adult Crohn’s Disease: an Overview of Clinical Practice and Perceived Barriers

“…Crohn’s disease (CD) is a chronic, idiopathic, and disabling inflammatory bowel disease (IBD), of unknown etiology that affects any segment of the gastrointestinal tract. 1 , 2 Recently, CD has evolved into a global burden, given its high incidence in developed countries and at the same time the substantial increase in incidence in developing countries. 3 Multiple factors, such as genetic background, environmental and luminal factors, and mucosal immune dysregulation, have been suggested to contribute to CD pathogenesis.…”