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PubMed1977

Symptomatic intestinal disaccharidase deficiency in alcoholics.

Lactase and sucrase activities were measured in jejunal biopsies from a group of alcoholic and nonalcoholic men of similar nutritional status, consisting of American blacks, and whites of northern European origin. When measured withing 10 days of alcohol withdrawal, sucrase activity was decreased by 33% in the alcoholics. Lactase activity was less than 1 U per g in 100% of the black and 20% of the white alcholics as compared to 50% of the black and none of the white control subjects. Lactase activity was virtually absent in 45% of the black alcoholics. A second jejunal biopsy after an additional 2-week period of alcohol abstinenece exhibited significant secondary increases in the activities of both disaccharidases. Oral administration of lactose (1 g per kg of body weight) resulted in significantly lower blood glucose concentration and higher incidence of adverse effects in alcoholics, mainly among the blacks. Although data from larger populations are needed to confirm our observations, these findings suggest that chronic alcohol ingestion decreases intestinal disaccharidase activities even in the absence of overt malnutrition. The decrease in enzyme activity produced by alcohol is associated with increased morbidity after lactose administration.

Adult↗
PubMed1985

Hydrogen concentration in expired air analyzed with a new hydrogen sensor, plasma glucose rise, and symptoms of lactose intolerance after oral administration of 100 gram lactose.

A rapid breath hydrogen analyzer to detect lactose malabsorption is described. After ingestion of a lactose solution the patient expires into a mouthpiece attached to a hydrogen sensor at 30-min intervals for 3 1/2 h. The hydrogen of the expired air causes a voltage change that can be transformed into ppm from a calibration curve. A tolerance test with a load of 100 g lactose was performed in 43 consecutive patients with various gastrointestinal disturbances, referred to the laboratory for the commonly used lactose tolerance test based on plasma glucose measurements. Eleven patients developed symptoms of lactose intolerance during the test. Biopsy specimens from the distal duodenum or proximal jejunum showed partial villous atrophy in one, in whom celiac disease with lactose intolerance was diagnosed; the other 10 had normal specimens. In nine of them lactose intolerance was diagnosed and confirmed by observation for months on a lactose-poor diet. The 10th patient (H.P.L.) did not improve on such a diet. He also showed pronounced symptoms of intolerance during a test with monosaccharides (glucose + galactose). His intestinal disease remained undiagnosed. The 11 patients with symptoms of intolerance and 3 patients without symptoms during the lactose load showed a flat plasma glucose curve after drinking the lactose solution--that is, a maximum rise of the glucose concentration of 1.5 mmol/l. One of the symptom-free patients dropped out and could not be observed, another did not improve on a lactose-poor diet, and the third noticed a favorable effect of the diet on stool consistency but not on other abdominal symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Giardiasis in childhood and its effects on the small intestine.

The effects of Giardia lamblia on small bowel function were studied. Thirty-three asymptomatic children were studied before and after treatment with metronidazole (Nimorazol). Patients had a small intestinal biopsy, bile salt determinations, and the following absorptive tests: D-xylose, triglyceride, and lactose and sucrose tolerance tests. Before treatment, 87% had unconjugated bile salts in duodenal fluid but afterwards only 60% did. Small bowel biopsy changes did not correlate with the pre- and posttreatment periods. Triglyceride absorption showed significant differences between patients at different periods of the study; D-Xylose absorption did not reveal differences between the periods of the study but was significantly impaired when compared with controls. Lactose malabsorption was detected in 56% and sucrose in 7% of the patients. G. lamblia may have some pathogenic role, although nonspecific to intestinal function. It probably acts more in a synergistic way with other pathogenic agents that inhabit the intestinal lumen of children living under unfavorable conditions producing the picture of tropical enteropathy.

Bile Acids and Salts↗
PubMed1985

Lactose malabsorption in Israeli children.

Lactose malabsorption during childhood was studied in 110 Jewish children in Israel, using the lactose hydrogen breath test. Sixty-eight subjects (61.8%) were lactose malabsorbers, 41 (60.3%) of whom were lactose-intolerant with symptoms evidenced during or following the tests, whereas 27 (39.7%) were symptom-free (tolerant malabsorbers). In the youngest age-group (4 months to 3 years), no lactose malabsorption was detected, whereas in the higher age-groups the prevalence of lactose malabsorption increased with age. The percentages of lactose malabsorption in the age-groups 3 to 6, 6 to 12 and 12 to 16 years were 56.5, 65.2 and 75.0%, respectively. The percentages of lactose-intolerant subjects also increased in the same age-group, to 26.5, 39.1 and 65.0%. There were no significant differences in lactose malabsorption and tolerance between the various ethnic groups tested. The peak values of breath hydrogen were higher in lactose-intolerant than in lactose-tolerant malabsorbers.

Adolescent↗
PubMed2002

Dietary calcium intake in lactose maldigesting intolerant and tolerant African-American women.

BACKGROUND: The relationship between lactose maldigestion, lactose intolerance, and calcium intake in premenopausal African American women is unknown. OBJECTIVE: To determine how intolerance of lactose and dairy products affects intake of calcium in lactose maldigesting premenopausal African American women. DESIGN: Dietary intake of calcium was assessed in 50 premenopausal lactose maldigesting African American women as determined by the breath hydrogen test. Twenty-six women were lactose intolerant and 24 were lactose tolerant by self-reports. RESULTS: The average intake of calcium in lactose maldigesting and intolerant women was significantly lower than in lactose tolerant women (388 +/- 150 mg/day vs. 763 +/- 333 mg/day, p < 0.0001, t test). Neither group reached the newly established Dietary Reference Intake (DRI) for calcium (1,000 mg/day). Major source of dietary calcium in lactose tolerant women were milk and dairy products (45%), and mixed foods containing calcium from non-dairy sources (30%). In lactose intolerant women, 46% of calcium was from mixed foods and only 12% was from milk and dairy products. Lactose intolerant women had higher body mass index (BMI) than lactose tolerant women (p = 0.008, t test), and calcium intake was negatively associated with BMI (R2 = 0.470). CONCLUSIONS: In African American premenopausal women, lactose tolerance facilitates the dietary intake of calcium when compared with their lactose intolerant counterparts. Low calcium intake is associated with higher BMI.

Adult↗
PubMed1988

Acidic colonic microclimate--possible reason for false negative hydrogen breath tests.

About 5% of normal subjects fail to produce increased hydrogen breath concentration after ingestion of the non-digestible carbohydrate lactulose (low hydrogen producers). The existence of low hydrogen producers limits the diagnostic use of hydrogen (H2) breath tests. We studied the effects of lactulose and of magnesium sulphate (MgSO4) pretreatment on stool-pH and on hydrogen exhalation after oral loading with lactulose or lactose in 17 hydrogen producers and 12 low hydrogen producers. In seven hydrogen producers acidification of stool pH by lactulose pretreatment (20 g tid) decreased hydrogen exhalation and three of seven (43%) became low hydrogen producers. In contrast, after pretreatment of eight low hydrogen producers with magnesium sulphate (5 g twice daily) all eight produced hydrogen after a lactulose load. Similarly four lactose intolerant low hydrogen producers had abnormal lactose hydrogen breath tests after MgSO4 pretreatment. MgSO4 pretreatment neither resulted in false positive lactose hydrogen breath tests in five lactose tolerant hydrogen producers, nor increased the hydrogen exhalation in five additional hydrogen producing controls after ingestion of lactulose. The results of these studies confirm that hydrogen production from lactulose decreases when the colonic pH is lower (lactulose pretreatment), and increases when colonic pH is higher (MgSO4 pretreatment). In low hydrogen producers the lacking increase of H2 exhalation after ingestion of non-digestible carbohydrates can be overcome by MgSO4 pretreatment, thus increasing the sensitivity of the test by avoiding false negative hydrogen breath tests in low hydrogen producers with disaccharide malabsorption or maldigestion. The underlying mechanism of this remarkable effect of MgSO4 pretreatment warrants further investigation.

Breath Tests↗
PubMed1995

Prospective study of lactose absorption during cancer chemotherapy: feasibility of a yogurt-supplemented diet in lactose malabsorbers.

Chemotherapy is a recognized cause of morphological alterations to the proximal intestine. Lactose malabsorption, the functional consequence of a small intestinal enzymatic derangement, has been shown to play an important role in causing gastrointestinal symptoms in subjects receiving chemotherapy. To establish a rational basis for the exclusion of lactose from the diet and to reduce the risk of developing gastrointestinal symptoms, we conducted a study of lactose absorption in 20 children during cancer chemotherapy. Because lactose is an important nutritional sugar, the tolerance of lactose provided by yogurt was examined. Lactose absorption was investigated by a hydrogen breath test (BT) after oral ingestion of milk (250 ml) containing physiological doses of lactose (12 g). The effect of yogurt supplementation was also tested by BT after meals of yogurt (450 g) also containing physiological doses of lactose (12.1 g). In 11 children, lactose malabsorption was detected by BT during the study before any gastrointestinal symptom revealed this status. Of these 11 children, no gastrointestinal discomfort developed in five receiving a lactose-excluded diet. In contrast, in the six children not restricted in lactose intake, gastrointestinal symptoms were observed 4 to 13 weeks after lactose malabsorption was detected by BT. The findings of our study suggested the usefulness of dietary supplementation with yogurt, a lactose-containing food, in children who developed lactose malabsorption. In fact, all lactose-malabsorbent children showed good lactose absorption and tolerance when tested by yogurt BT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Increased levels of hyaluronan and albumin after intestinal challenge in adult patients with cow's milk intolerance.

BACKGROUND: The mechanisms for adverse reactions to foods in the gastrointestinal tract are poorly understood. Presently, only limited possibilities are available for identification of adverse immunological reactions to different foods. OBJECTIVE: The intestinal inflammatory reactions in adult patients with a history of milk-related gastrointestinal symptoms were studied after intestinal challenges by a jejunal perfusion technique and compared with the reactions in a control group. METHODS: Five skin-prick test and radioallergosorbent test negative and lactose tolerant patients with a history of milk-related gastrointestinal symptoms, verified by double-blind placebo-controlled challenge, and eight healthy controls were investigated. Perfusions were performed allowing analyses of a well-defined 'closed' jejunal segment. Milk perfusions were performed in patients and controls after an overnight fast. Ten millilitres of milk were administered to the segment at 3 mL/min. The jejunal fluid levels of hyaluronan (hyaluronic acid) and albumin were measured. RESULTS: In the five patients the milk challenges induced as a mean fivefold increased levels of hyaluronan compared with prestimulation values, whereas no such increases were seen in the control subjects. Albumin, as a marker of plasma leakage, was also increased in the patients but not in the control subjects. CONCLUSION: The underlying mechanisms for locally increased levels of hyaluronan and also albumin in the intestinal lumen may be secretion of lymph rich in hyaluronan and reflect the mucosal oedema. This capacity of the intestinal mucosa to react with lymph leakage towards a locally infused allergen may be a possible way to delineate gastrointestinal reactions in food-related disorders.

Adult↗
PubMed1984

Familial amyloidosis with polyneuropathy. Aspects of the relationship between gastrointestinal symptoms, EMG findings, and malabsorption studies.

Fifty-two patients with a confirmed diagnosis of familial amyloidosis with polyneuropathy living in northern Sweden were investigated. Gastrointestinal symptoms, mainly in the form of changed bowel habits, were found in 47 patients. Symptoms of polyneuropathy of the peripheral nerves usually preceded the gastrointestinal symptoms, but in 12 patients gastrointestinal dysfunction started either before or simultaneously with the neurological symptoms. Steatorrhea was found in 30 patients (58%) and an impaired D-xylose absorption in 52%. Diarrhea, anal incontinence, and a high degree of peripheral denervation indicating a severer disease were related to the presence of steatorrhea. The results of oral lactose and glucose tolerance tests were essentially normal. The results suggest that the main reason for the gastrointestinal dysfunction is a disruption of the gut autonomic nervous system rather than a barrier to the absorption of nutrients across the intestinal wall.

Adult↗
PubMedDate not supplied

[Tropical enteropathy: morphologic and functional changes of the small intestine and their effects on nutritional status].

Tropical enteropathy has been described in children and adults that live in developing countries. This disease may be symptomatic or may present without symptoms. We studied 66 patients with tropical enteropathy with special reference to the nutritional status and the intestinal function. The follow-up of the nutritional status revealed that 63 (95.49%) presented current malnutrition. The D-xylose absorption test was significantly lower than those found in the control group. The mean plasmatic triglyceride increment after the margarine load was significantly lower than that found in the control group. Carbohydrate tolerance tests revealed 51.3% lactose malabsorption, 35.07% sucrose malabsorption and 5% glucose malabsorption. Small bowel biopsy showed partial villous atrophy as the most frequent morphological characteristic observed. These children constitute an homogenous group representative of the majority of the population of the Third World.

Child, Preschool↗