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PubMed1994

Increased intestinal sugar permeability after challenge in children with cow's milk allergy or intolerance.

The diagnosis of cow's milk allergy or intolerance (CMAI) is based on clinical improvement on exclusion diet and relapse after challenge with milk. The aim of this work was to investigate the value of the cellobiose/mannitol (C/M) sugar permeability test, performed before and after cow's milk challenge, as a tool for the diagnosis of CMAI. Thirty-two patients underwent milk challenge at a median age of 13 months (range 3-84 months). A dual sugar (C/M) permeability test with an iso-osmolar solution was performed before and 24 h after challenge. Of the 10 patients who developed symptoms after challenge, nine showed increased postchallenge C/M ratio, whereas such an increase was observed in only one of the 22 nonrelapsed subjects. The postchallenge C/M ratio increase in relapsed subjects is to be attributed to both higher cellobiose and lower mannitol urinary excretion. These results suggest the use of the sugar permeability test, in addition to clinical observation, as an aid in the evaluation of provocation tests in infants with suspected CMAI.

Animals↗
PubMed1977

Food hypersensitivity allergy or malabsorption.

The terms milk allergy, milk sensitivity, and milk intolerance are used in the medical literature with different meanings. Milk allergy and lactase deficiency to which they are usually referring can be specifically differentiated and diagnosed. A modification of the Rinkel oral test meal can be used to separate these two entities for medical diagnostic accuracy and understanding.

Animals↗
PubMed2002

Irritable bowel syndrome and nonspecific diarrhea in infancy and childhood--relationship with juice carbohydrate malabsorption.

Lactose intolerance and malabsorbed carbohydrate present in some fruitjuice may trigger symptoms commonly seen in irritable bowel syndrome. In a two-site study, 28 subjects 9 months to 18 years old (mean 6.9 +/- 5.9 years) with significant intake of apple juice or pear nectar (> 6 oz a day) with the diagnoses of irritable bowel syndrome, functional abdominal pain, or chronic nonspecific diarrhea were recruited. Breath hydrogen tolerance tests utilizing lactose, sucrose, and apple juice in the amount they typically consumed were positive in 32%, 0%, and 50%, respectively. Subjects were asked to refrain from the ingestion ofjuice for 1 month: 13 of the 28 (46%) subjects improved while 15 (54%) showed no change in their symptoms. In fact, none consuming 6 to 12 oz of apple or pear juice daily improved, 27% of those consuming 12 to 16 oz improved, and 91% of those consuming > 16 oz improved (P < 0.02). Subjects were then given comparable amounts of white grape juice for 1 year. The initial symptoms did not recur in any of the subjects who initially responded to the juice-free diet. Of the 15 subjects who did not respond to the juice-free diet, seven became asymptomatic. Overall, 20 subjects (71%) were asymptomatic, and eight (29%) had no change in their symptoms. Some individuals with irritable bowel syndrome have their symptoms based on their malabsorption of carbohydrates present in apple juice and pear nectar and may improve with adequate choices of fruit juice such as changing to white grape juice.

Adolescent↗
PubMed2006

A biopsy-based quick test in the diagnosis of duodenal hypolactasia in upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The usefulness of a new quick test for endoscopic diagnosis of adult-type hypolactasia was tested in duodenal biopsies. In this test, an endoscopic biopsy from the postbulbar duodenum is incubated with lactose on a test plate, and a color reaction develops within 20 min as a result of hydrolyzed lactose (a positive result) in patients with normolactasia, whereas no reaction (a negative result) develops in patients with severe hypolactasia. PATIENTS AND METHODS: Two postbulbar duodenal biopsies were taken from 80 prospectively enrolled adult outpatients with dyspepsia. The biopsies were used for the Quick Lactase Test (Biohit PLC, Helsinki, Finland) and in biochemical disaccharidase (lactase, sucrase, and maltase) assays. In addition, the C/T (-13,910) genotype was determined from DNA extracted from gastric antral biopsies using polymerase chain reaction sequencing in genomic analysis of adult-type hypolactasia. RESULTS: Twenty-one of 22 patients (95 %; 95 % CI, 87 - 100 %) with biochemical lactase activity < 10 U/g protein, but none of the 58 patients with lactase activity of 10 U/g protein or more had a negative result in the Quick Lactase Test. Seven of the 80 patients (9 %; 95 % CI, 3 - 15 %) had a Quick Lactase Test result that indicated mild hypolactasia (a mild color reaction). All patients with celiac disease (n = 6) had a negative Quick Lactase Test result. Nine of 74 patients (six patients with celiac disease were excluded) had a CC (-13,910) genotype in genomic testing, indicating adult-type hypolactasia. All of them had negative test results with the Quick Lactase Test. Twenty-six patients had a TT genotype, indicating normolactasia, and none of these patients had a negative test result in the Quick Lactase Test. Six of 39 patients (15 %; 95 % CI, 4 - 27 %) with a CT genotype had a negative result in the Quick Lactase Test. CONCLUSIONS: The Quick Lactase Test effectively identifies patients with severe duodenal hypolactasia. In comparison with CC (adult-type hypolactasia) and TT individuals (normolactasia), the sensitivity and specificity of the Quick Lactase Test result was 100 %. In comparison with biochemical lactase assays, the sensitivity and specificity of a negative Quick Lactase Test for indicating hypolactasia (lactase activity < 10 U/g protein) were 95 % (95 % CI, 87 - 100 %) and 100 %, respectively.

Biopsy↗
PubMed1996

[Use of enzyme substitutes in hypolactasia].

The paper presents the results of clinical and laboratory studies of lactrase, a drug containing lactase. This agent is recommended for splitting lactic sugar in subjects with appreciably decreased production of endogenous lactase (hypolactasia). Twenty-eight patients with this condition were examined. Manifest clinical symptoms of the condition were observed after loading with 50 g of lactose in all examinees. Addition of 250 mg of lactrase to lactose led to complete clinical compensation of the deficit of endogenous lactase in 75% examinees, and if 500 mg of lactrase was administered, hypolactasia was compensated in virtually all patients. A single intake of 50 g of lactose with lactrase causes a statistically reliable increase of glycemia in such patients. Moreover, a reliable effect of lactrase was observed when measuring galactose in the urine following the lactose test with 250 and 500 mg of lactrase. Our results indicate a high efficacy of lactrase in the treatment of patients with hypolactasia.

Adolescent↗
PubMedDate not supplied

Lactose intolerance in a calf.

Lactose intolerance was identified as the cause of bovine neonatal diarrhea. Glucose and xylose oral absorptions were normal whereas lactose absorption was reduced relative to normal calves. Lactase deficiency is common in people but rarely reported in animals. The treatment of whole milk with lactase alleviated the diarrhea.

Absorption↗
PubMed1991

[Lactase deficiency and lactose intolerance-related symptoms in adult healthy subjects from western France].

The prevalence of lactase deficiency (LD) and lactose intolerance is not well known in France. Using breath hydrogen and methane analysis after 50 g oral lactose load, we investigated the prevalences of LD, lactose intolerance, and methane producer status in 102 healthy adults born in western France, and we examined the relationships between these parameters and the daily milk consumption. In 10 subjects with LD and lactose intolerance, we studied the reproducibility of the lactose hydrogen breath test results for the diagnosis of LD and lactose intolerance and estimated the quantity of lactose malabsorbed in comparison with the lactulose hydrogen breath test. The prevalence of LD was 23.4 percent and symptoms of lactose intolerance were observed in 50 percent of the 24 subjects with LD. The daily milk consumption was not significantly different in the 24 subjects with LD and in the 78 subjects without LD (281 +/- 197 vs 303 +/- 217 ml/24 h). The prevalence of methane producer status was 42.1 percent. The symptomatic group of lactose malabsorbers (n = 12) was characterized by a shorter lactose mouth to caecum transit time (39 +/- 20 vs 88 +/- 48 min; P less than 0.05), and more marked hydrogen production (6.1 +/- 2.3 vs 3.4 +/- 2.4 10(3) ppm.min; P less than 0.04). In the 10 subjects with LD and lactose intolerance, the hydrogen breath test was reproducible for diagnosis of LD and lactose intolerance, and for hydrogen production. The quantity of lactose malabsorbed was 60 percent. In France, symptoms of lactose intolerance are not severe and do not affect the daily consumption of milk and dairy products.

Abdominal Pain↗
PubMed1976

Lactose malabsorption in Thai infants and children: effect of prolonged milk feeding.

More than one-third of Thai infants were lactose malabsorbers soon after birth and the percentage of lactose malabsorption increased with age. Beyond 4 years of age, all Thai children studied were lactose malabsorbers. Continued milk supplementation over the study period did not affect the ability to digest lactose in the amount given in the load test. Since the milk-supplemented group of children tended to have better weight gain and few undesirable gastrointestinal symptoms, it seems milk feedings can be used to advantage even among populations with a record of high lactose intolerance.

Animals↗
PubMedDate not supplied

Persistent high intestinal lactase activity in Papua New Guinea. Lactose absorption curves in two populations.

Thirty adolescent males, aged 16-19 years, all of Huli, Mendi or Dunai descent, sampled at Tari in Southern Highlands of Papua New Guinea, and 29 children aged between 9 and 15 years, all speakers of Daga and sampled at Agaun in the Milne Bay Province, have been tested for persistent high intestinal lactase activity. Three persons at Tari and five at Agaun were found to be lactose absorbers. There is reasonably convincing evidence that all five absorbers at Agaun descend from a common ancestor five generations ago, but there is no such suggestion for those tested at Tari. Gene flow from Caucasoids who penetrated both areas is possible. The presence of lactose absorbers in peoples who are not traditional users of fresh milk suggests that the culture historical hypothesis may not give a completely adequate explanation for the establishment and conservation of the lactose polymorphism in man.

Adolescent↗
PubMed1994

[Modified test with oral lactose loading for detecting lactose intolerance in young children].

Twenty-four children with persistent diarrhea or intestinal dysfunction were examined; lactose, glucose with galactose and lactic acid levels in their feces were not a convincing evidence of lactose intolerance. Detection in the feces of elevated levels of 2 or more parameters after oral lactose load (2 g/kg, not more than 15 g), as well as an increment of a previously elevated value or its manifestation evidenced lactose intolerance. No increase of carbohydrate levels or lactic acid in the feces were observed in the group of 21 age-matched controls.

Child, Preschool↗
PubMedDate not supplied

Lactose absorption in a Western Massim population.

A sample of adults from Goodenough Island represents the first Austronesian- speaking series to be tested for lactose absorption. The results found were similar to those for non-Austronesian-speakers tested on the nearby mainland of Papua New Guinea. It is not yet possible to conclude whether the polymorphism, so unexpectedly present in populations with no history of milk utilization, is an example of founder effect or whether it is kept in existence by selection. The common ancestors probably present in this and one previous series suggest that recent founder effect may be important.

Blood Glucose↗
PubMed1982

Distribution of human adult lactose phenotypes in Egypt.

Lactose absorption was studied in 570 health adolescent and adult males in Egypt. Employing a field version of the noninvasive hydrogen breath test, 156 (27.4%) lactose absorbers and 414 (72.6%) lactose malabsorbers were identified. The age-specific prevalence of the lactose phenotypes indicated that lactase repression is complete at the age of 14 years in Egyptians. The regional distribution showed significant differences between the Nile Delta and the northern and southern part of Upper Egypt. The existence of a north-south gradient of decreasing frequencies of the hypolactasia gene from the Nile Delta to the Sudan is suggested.

Adolescent↗
PubMedDate not supplied

Gastric emptying of lactose and glucose-galactose in patients with low intestinal lactase activity.

To test the hypothesis that in subjects with low intestinal lactase activity (LLA) lactose solutions leaves the stomach at an abnormally fast rate, we have measured the gastric emptying rate of solutions of lactose and glucose-galactose in patients with LLA (n = 9) and in control subjects with high intestinal lactase levels (n = 7) as proved by the assay of disaccharidases in specimens of intestinal mucosa. The volume of the test meals was 300 ml. Lactose solutions contain 50 g of disaccharide and glucose-galactose solutions contain 25 g of each monosaccharide. The volumes remaining in the stomach at different times after the intragastric instillation of the test meals were estimated by the double sampling test meal. In the control group, minor differences between lactose and glucose-galactose gastric emptying rates was found. By contrast, in LLA patients, the lactose meal left the stomach at a significantly faster rate than the glucose-galactose test meal. These findings support previous evidence obtained in patients with putatively low intestinal lactase activity and are consistent with the view that duodenal osmoreceptors, whose excitation results in inhibition of gastric emptying, lie deeper than the disaccharidases in intestinal mucosa. Thus, incomplete hydrolysis of lactose results in a faster than normal gastric emptying rate of the sugar and this may contribute to the symptoms found in LLA patients after milk ingestion.

Adult↗
PubMed1993

[Long-term follow up study of children with celiac disease].

27 long term monitored coeliac children were assessed. The average length of follow-up was 6.4 years, the average age of the children was 11.5 years (ranging 6.3 to 20.1 years). Of the 11 boys and 16 girls 4 adolescents consume a normal diet, while another 2 are on semistrict diet, all 6 of them without any enteral symptoms. Out of the 15 children aged younger than 13 years 9 are on a strict diet. Semistrict diet has an impact on gliadin antibody levels respectively. Serum ferritin levels of those on a normal diet are significantly lower than those of the control group. Out of the 25 lactose breath tests 7 showed abnormal results, irrelevant both to the strictness of the diet and to gliadin antibody levels. In the view of weight and length percentiles there is no difference at present between those eating normal food and diet. Nevertheless, with regards to the risk of malignancy in coeliac disease the necessity of a strict diet must be stressed. In long term follow-up the levels of gliadin antibodies and of serum ferritin are of pathognostic importance.

Adolescent↗
PubMed1987

Effective reduction of lactose maldigestion in preschool children by direct addition of beta-galactosidases to milk at mealtime.

We examined the efficiency of two beta-galactosidase preparations--one derived from the yeast, Kluyveromyces lactis (Lactaid), the other derived from the fungus, Aspergillus oryzae (Takamine)--to assist the in vivo digestion of lactose consumed by healthy Guatemalan preschool children. Milk prehydrolyzed by in vitro incubation with enzymes was used as the standard of reference, and the degree of incomplete digestion of lactose from 240 mL of milk was determined using the hydrogen breath test. In in vivo dose-response studies, both 3,250 neutral lactose units of Lactaid and 6,635 food and chemical codex lactose units of Takamine completely eliminated excess H2 excretion in a small sample of lactose-maldigesting subjects. When evaluated in a controlled, clinical trial setting, the same dose of Lactaid added directly to the milk at consumption produced an 82% relative reduction in H2 excretion, whereas Takamine was equally as effective as the prehydrolyzed milk. Thus, intraluminal conditions and gastrointestinal transit in the preschool child support the effective assisted digestion of milk lactose in an efficient manner and with the same enzyme to milk ratios as observed previously in adults.

Animals↗
PubMed1975

Lactose hydrolyzed milk.

Lactose intolerance is being reported in many populations. Yet, milk is highly nutritious and methods are being explored to use milk while limiting the lactose content. Thirty-two blacks 13-19 years of age were studied to determine a blood sugar rise with 8 ounces of the following test milks: 1) untreated whole milk (12 g/lactose); 2) 90% lactose hydrolyzed milk (1.2 g/lactose); and 3) 50% lactose hydrolyzed milk (6 g/lactose). In the 22 lactose malabsorbers, the peak blood sugars were: 1) untreated whole milk--4.4 mg/100 ml, 2) 90% lactose hydrolyzed milk--14.5 mg/100 ml, and 3) 50% lactose hydrolyzed milk--8.8 mg/100 ml. The 10 blacks with normal lactose absorption had a comparably high peak blood sugar on all three test milks. Differences between the blood sugar in the lactose absorbing and malabsorbing subjects when drinking untreated whole milk are significant (P less than 0.001); so are differences in the lactose malabsorbing subjects consuming untreated whole milk and 90% lactose hydrolyzed milk (P less than 0.001) as well as 50 and 90% lactose hydrolyzed milk. Symptoms were reported by three lactose malabsorbing subjects with untreated whole milk with two of the three symptomatic with 90% lactose hydrolyzed milk and none with 50% lactose hydrolyzed milk. No symptoms were reported by the lactose absorbers. Significant improvement in absorption with 90% lactose hydrolyzed milk is seen in low lactase subjects. Lactose hydrolyzed milk may serve as an important alternative for food planners wanting to provide milk to high risk populations with low lactase levels.

Adolescent↗
PubMed1975

Lactose intolerance among Mexican Americans.

Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.

Adolescent↗