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Abstract

Lactulose has been proposed to be beneficial in treating inflammatory bowel disease (IBD). The hypothesis is based on the prebiotic potential of lactulose. A practical approach to testing its usefulness is to determine colonic adaptation to tolerable doses in patients with IBD. Our objective was to determine if a 3-week course of lactulose will decrease BH2 and symptoms in response to an acute lactulose challenge test in control subjects and IBD patients. The design was a prospective cohort study. Subjects were given a 30-g lactulose challenge test (test 1), and then ingested 10 g of lactulose twice a day for 3 weeks before being retested (Test 2). A third test was given after a further 5-week washout period. The main outcomes were the change in 4-hr sum of BH2 (sum(4HrBH2)) values obtained every 30 min, peak BH2, and 4-hr sum of symptom score (sum(4HrSS)) during the lactulose challenge test. In addition, we also report the change in self-reported symptoms and diarrhea during the 3-week administration of lactulose. In controls, sum(4HrBH2) decreased from test 1 (380.5 +/- 56.6 ppm) to test 2 (288.6 +/- 57.4 ppm) (P < 0.05), and returned toward test 1 levels by test 3 (307.5 +/- 53.1, P > 0.5). Unlike controls, the sum(4HrBH2) in patients failed to achieve significance between test 1 (444.5 +/- 55.8 ppm), test 2 (366.5 +/- 80.7 ppm, P > 0.2) or test 3 (411.6 +/- 62.5 ppm, P > 0.2). Sum(4HrSS) results in controls followed a pattern similar to sum(4HrBH2), achieving significance only in test 2 (P < 0.02). Symptoms during the intertest periods decreased by the third week in controls (P < 0.05), but not in patients (P > 0.5). Symptoms were lower in patients and varied insignificantly both in challenges and intertest periods. In conclusion, although controls adapt to a 3-week period of lactulose ingestion, IBD patients fail to meet the criteria for adaptation. However, longer studies may be needed to establish whether IBD patients are slower to adapt.

Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases

“…However ability to adapt to lactose in IBD is unclear and there are no formal trials. Using lactulose, a disaccharide with similar properties to lactose failed to show adaptation compared with healthy controls [ 79 ]. Pironi et al however may have detected microbial adaptation since despite increased LM status only 8 % of CD patients were also LI [ 37 ].…”

Mechanisms of Action of Prebiotics and Their Effects on Gastro-Intestinal Disorders in Adults

“…Hafer et al conducted a pilot study on 31 subjects suffering from IBD (both UC and CD) and found that a 10 g lactulose administration did not show any beneficial effect, except for an improvement of the clinical symptoms and the quality of life of patients with CU, without significant modifications at the endoscopic level [142]. As Fellerman et al reported, this discrepancy could be related to a defensin deficiency in IBD, which is reversible only in UC and not in CD patients, following lactulose administration [143,144].…”

Adaptation to Lactose in Lactase Non Persistent People: Effects on Intolerance and the Relationship between Dairy Food Consumption and Evalution of Diseases

“…This could be due to overt or subtle small bowel involvement. Furthermore, adaptation to the disaccharide lactulose was unsuccessful in patients with Crohn’s disease compared with healthy controls [ 153 ].This suggests a reason also why Crohn’s patients may have more difficulty with DFs containing lactose.…”