[Tolerance test with lactose and other disaccharides].
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Adult↗
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Gut transit time and lactose malabsorption during phototherapy. II. A study using raw milk from the mothers of the infants.
Thirty newborn infants with normal birth weight suffering from uncomplicated hyperbilirubinemia were studied. 15 infants received ordinary phototherapy and 15 intensive phototherapy (blue double light). All infants received their mothers' milk or fresh milk from mothers of other newborn infants of the same age. All infants had normal lactose tolerance test during the phototherapy, except one infant receiving ordinary transit time was relatively long. The gut transit time was significantly shorter in the infants treated with intensive phototherapy than in those treated with ordinary phototherapy without there being any significant difference in the increase in blood glucose by lactose tolerance tests. It is concluded that lactose malabsorption is not the usual cause of the reduced gut transit time during phototherapy even if the infants receive their mothers' milk.
Bilirubin↗
Lactose malabsorption among Masai children of East Africa.
There is much disagreement about milk and its use in feeding programs both in the United States and internationally. A few authors suggest that milk consumption should not be encouraged in lactose intolerant populations due to adverse symptoms. Others suggest, however, that small or modest quantities of milk can be tolerated and can be nutritionally useful to such groups. Data are presented in this paper that show that 1) the Masai regularly drink considerable quantities of milk without apparent symptoms, 2) milk is an important constituent of the Masai diet, and 3) 62% of 21 Masai examined were malabsorbers of lactose as measured by the lactose tolerance test. This finding of lactose malabsorption in a nomadic cattle raising and milk drinking people is interesting and is contrary to the views often expressed by anthropologists and others. An ability to drink nutritionally useful quantities of milk does not, however, necessarily mean that milk production or imports should be encouraged in the Lesser Developed Countries.
Adolescent↗
The role of urinary indican as a predictor of bacterial colonization in the human jejunum.
To evaluate the role of urinary indican excretion and several common absorptive tests as predictors of bacterial colonization in the human jejunum, we analyzed the relationship between indican excretion and quantitative jejunal cultures, tryptophan absorption, enteric protein loss, fecal nitrogen excretion, D-xylose and lactose tolerance tests, and B12 and fat absorption in 40 subjects. Indican excretion correlated poorly with jejunal colony counts (r = 0.22). Neither tryptophan load or absorption, nor nitrogen excretion were related to indicanuria, but there was a modest correlation between enteric protein loss and urinary indican values (r = 0.54). Lactose tolerance tests and D-xylose, B12 and fat absorption showed no predictive value for identifying patients with high colony counts. Compared to quantitative small bowel culture, none of the tests studied provided suitable methods for screening for bacterial contamination of the human jejunum.
Albumins↗
Comparison of a portable breath hydrogen analyser (Micro H2) with a Quintron MicroLyzer in measuring lactose maldigestion, and the evaluation of a Micro H2 for diagnosing hypolactasia.
The measurement of hydrogen in exhaled air and changes in the concentration of blood glucose and urine galactose excretion are indirect methods of diagnosing hypolactasia. The aim of this study was to compare a portable breath hydrogen analyser (Micro H2) with a widely used model (Quintron MicroLyzer) and to compare them with the blood glucose, urine galactose, and gastrointestinal symptoms in the lactose tolerance test. After an overnight fast, 44 volunteers (18-66 y) ingested 50 g lactose in a single oral dose. Changes in exhaled breath hydrogen concentrations were measured with the two analysers, and changes in blood glucose and urinary galactose were assayed for 4 h and used as a reference. Eighteen subjects were diagnosed as maldigesters according to our gold standard of at least two positive tests out of the three: breath hydrogen by Quintron, blood glucose concentration, and urine galactose excretion. The highest increase in the breath hydrogen concentration over the baseline was highly variable: 44-366 ppm (Micro H2) or 27-187 ppm (Quintron MicroLyzer). The sensitivity, specificity, and positive and negative predictive values of the Micro H2 compared to the gold standard were 83%, 96%, 94% and 89%, respectively. Overall agreement was 91% (95% CI 78-97%). Compared to the Quintron, the diagnoses were identical in 100% of the cases (92-100%). Thus, for diagnosing hypolactasia, the Micro H2 appeared as reliable for measuring breath hydrogen concentrations as Quintron MicroLyzer commonly used in oral lactose tolerance tests.
Adolescent↗
[Anatomical and functional changes of the human small intestine induced by 5-fluorouracil (author's transl)].
In 10 female patients with carcinoma the effect of a single dose of 5-fluorouracil on morphologic alterations of the small bowel mucosa, intestinal disaccharidase-activities and lactose-tolerance-test was studied pre- and 96 hours posttherapy. After having given a standard dose of 1,25-1,50 gr 5-fluorouracil intravenously ( = 22 mg per kilo body weight) histologic changes of the small bowel mucosa (slight edema and shortening of the villi) were noted only in 4 cases. In the other cases the small intestine showed no morphological alterations of the mucosa. In all patients the lactose-tolerance-test after therapy with 5-fluorouracil was not affected. Following the administration of 5-fluorouracil no reduction of intestinal disaccharidase activities (maltase, saccharase, lactase) was observed. As a consequence of our results we suppose, that a patient given a single dose of 5-fluorouracil intravenously needs no specific diet without milk or milk-products.
Adult↗
[14CO2 exhalation tests. Diagnostic improvement in gastroenterologic diseases].
For evaluation of 14CO2-breath-tests the three most employed tests, namely glycero-14C-tripalmitate-test, 14C-lactose-tolerance-test, and 14C-glycin-cholate-test, were performed in healthy volunteers (n = 69), patients with chronic pancreatitis (n = 18), manifest malassimilation (n = 8), lactase deficiency (n = 15), and patients, in whom a disturbed enterohepatic bile salt circulation was suspected (n = 19). Usefulness of malabsorption tests was limited by many false normal results. Cholylglycin-breath-test on the other hand was sensitive, but clinical significance remained questionable. In our opinion simple performance and lacking discomfort are no sufficient arguments for 14CO2-breath-test.
Carbon Dioxide↗
Lactose absorption, milk consumption, and fasting blood glucose concentrations in women with idiopathic osteoporosis.
Lactose tolerance tests were performed in 33 women with osteoporosis and 33 control women matched for age. A questionnaire was used to elicit any history of milk intolerance and the subjects' daily intake of calcium derived from milk and dairy products. Eleven patients and four controls gave a history of milk intolerance (p less than 0.01); 13 patients had lactose malabsorption compared with four controls (p less than 0.01). The daily intake of calcium derived from milk was significantly lower in patients (125 (SEM 20) mg v 252 (43) mg; p less than 0.05). Curves of blood glucose concentrations during the lactose tolerance test in subjects with lactose malabsorption were significantly flatter in patients than controls (p less than 0.05). The fasting blood glucose concentration was higher (5.44 (0.17) mmol/l (98 (3) mg/100 ml) in the patients than the controls (4.88 (0.11) mmol/l (88 (2) mg/100 ml); p less than 0.05), although body weight was significantly lower (61.6 (2.2) kg v 66.3 (1.6) kg; p less than 0.05). Absorption of lactose is significantly impaired in women with "idiopathic" osteoporosis; this combined with low consumption of milk and a subclinical disorder of glucose metabolism may be a major factor in the development of idiopathic osteoporosis in women.
Adult↗
Gastrointestinal dysfunction in a community sample of subjects with symptoms of irritable bowel syndrome.
BACKGROUND/AIM: Irritable bowel syndrome (IBS) affects about 15-20% of the population of the Western countries. Traditionally, IBS has been an exclusion diagnosis, but recently definitions have emerged from population-based research. The aim of this population-based study was to evaluate any association between gastrointestinal pathophysiology and IBS in subjects with symptoms of IBS compared to subjects with no abdominal complaints. METHODS: From a random sample of 2,656 participants, subjects with IBS (32) together with subjects without abdominal complaints (26), were invited for further evaluation. IBS was defined as more than weekly experience of abdominal pain and distension, and in addition either borborygmia or altering stool consistency. The diagnostic work-up consisted of gastroscopy, manometry and 23-hour pH and pressure recordings of the oesophagus, lactose tolerance test, barium enema, measurement of colonic transit time, and rectoscopy. RESULTS: Compared to the group without abdominal complaints significantly more subjects with IBS had spasms of the colon (OR = 10.2 (1.2-87.3)), and abnormal contractions of the oesophagus at manometry (OR = 9.1 (1.1-78.2)). Furthermore, there was a non-significant tendency towards spasms at 23-hour pH and pressure recordings (OR = 3.58 (0.4-35.2)), and more discomfort at lactose tolerance test (OR = 5.8 (0.6-51.3)) in persons with IBS compared to subjects without abdominal complaints. CONCLUSION: The results of this population-based study indicate that signs of gastrointestinal dysmotility and hyperperception are more prevalent in subjects with IBS than in subjects without abdominal complaints.
Adult↗
Age-related changes in carbohydrate tolerance in healthy neonatal calves.
Calves at 3 to 4 days of age had higher plasma glucose concentrations during glucose and lactose tolerance tests (orally administered glucose and lactose) than when the calves were 8 to 9 days old. These observations may be accounted for by decreased insulin secretion and/or insulin sensitivity of the target tissues. Lower hepatic glucokinase activity in neonates also may allow increased passage of splanchnic glucose to the system circulation.
Aging↗
Disaccharidase levels in the small intestine in patients with diarrhoea following vagotomy and pyloroplasty.
Diarrhoea is a common sequel to vagotomy and pyloroplasty but its cause is unknown. One of our patients who developed this complication had an abnormal lactose barium meal and responded well to a lactose-free diet. This led us to make a systematic study of disaccharidase activity in the small intestine in patients with diarrhoea following vagotomy and pyloroplasty. The small-intestinal disaccharidases have been estimated in jejunal biopsy specimens taken from 23 patients suffering from persistent diarrhoea, either continuous or episodic, after vagotomy and pyloroplasty. The disaccharidase values were normal in all but one of these patients. This patient showed hypolactasia but the sucrase and maltase levels were normal. The jejunal biopsy specimen taken from this patient showed a convoluted pattern under the dissecting microscope and severe partial villous atrophy under the light microscope. A repeat jejunal biopsy taken 20 cm beyond the duodeno-jejunal flexure showed similar appearances and also had a low level of lactase. However, two lactose tolerance tests and a lactose barium meal yielded normal results, suggesting that the low level of lactase in the upper jejunum was not a limiting factor in lactose absorption. The finding of one example of a low lactase level among 23 postvagotomy patients corresponds with what is being found in a study of normal subjects at present in progress. In effect, almost all patients with persistent diarrhoea after vagotomy and pyloroplasty have normal small-intestinal disaccharidase activity.
Adult↗
Differential effects of chemical and physical restraint on carbohydrate tolerance testing in nonhuman primates.
Ketamine hydrochloride, used during glucose or lactose tolerance tests to aid restraint of rhesus and stumptail macaques unconditioned to handling, prevented the establishment of definitive baseline plasma glucose tolerance curves from which meaningful interpretations could be derived. Repetition of the tests after the animals were restraint-chair conditioned provided clear baseline control data. It is suggested that ketamine might invalidate those carbohydrate tolerance tests which are based on the absorption of glucose from the gastrointestinal tract.
Anesthetics, Dissociative↗
Combined lactose-D-xylose tolerance test in infancy.
A modified combined oral lactose-D-xylose tolerance test done on ten normal infants showed peak levels of blood glucose and D-xylose levels comparable to the peaks obtained when these tests were done separately in the same subjects. The combined test is recommended to evaluate digestive absorptive function in preference to two separate tolerance tests.
Blood Glucose↗
Small-bowel involvement in dermatitis herpetiformis and in linear-IgA bullous dermatosis.
In 23 patients with dermatitis herpetiformis (DH) and five patients with linear-IgA bullous dermatosis (BD), we evaluated the occurrence of histologic jejunal changes and small-bowel function abnormalities. None of the patients showed clinical signs or symptoms of malabsorption. Morphological jejunal changes consistent with gluten-sensitive enteropathy were found in 82% of DH patients and in 60% of BD patients. However, BD patients showed only mild jejunal histologic abnormalities, whereas more severe jejunal lesions were found in most patients with DH. Functional tests showed a rough correlation with the severity of the jejunal lesions, being almost completely normal in BD patients and DH patients with mild intestinal damage, whereas most of DH patients with subtotal or total villous atrophy showed abnormal d-xylose tests and folic acid assays. Lactose tolerance tests (H2 breath test and blood glucose after oral lactose load) showed no correlation with the degree of jejunal damage.
Adult↗
Incidence and clinical significance of lactose malabsorption in ulcerative colitis and Crohn's disease.
The incidence of lactose malabsorption was investigated in 85 patients with ulcerative colitis and 71 patients with Crohn's disease by means of lactose tolerance tests and disaccharidase determinations in small intestinal mucosa. Eight patients with ulcerative colitis (9%) and four with Crohn's disease (6%) had lactose malabsorption. A control group displayed a similar incidence. It is concluded that lactose malabsorption is not particularly common in ulcerative colitis and Crohn's disease. If it is present, its aetiology seems to be unrelated to the intestinal disease. Transitional lactose malabsorption was detected in two cases during a relapse of ulcerative colitis. Institution of a lactose-free (or lactose-poor) diet was an important supporting measure in seven patients who were unaware of their milk intolerance, in particular in two with ileostomy. Therefore, it is recommended that a lactose tolerance test should always be performed in patients with ulcerative colitis or Crohn's disease.Twenty-one patients with ulcerative colitis and nine with Crohn's disease, none of whom had lactose malabsorption, were placed on milk-free diets. A beneficial effect was noticed in five of the patients with ulcerative colitis, and in three of those with Crohn's disease. The mechanism is unknown. Evidence is presented that milk allergy is not responsible for the beneficial effect of a lactosefree diet in patients with associated lactose malabsorption.
Adolescent↗
Lactose intolerance in Thai adults.
Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.
Adult↗
Influence of the pharmacological modification of gastric emptying on lactose digestion and gastrointestinal symptoms.
BACKGROUND: In lactose maldigesters the ingestion of food which retards gastric emptying improves tolerance to lactose. AIM: To study the effects of the pharmacological modification of gastric emptying on the speed of development of lactose-induced symptoms. METHODS: After an overnight fast, 18 lactose maldigesters were given, in a randomized double-blind study design at 1-week intervals, either propantheline (as bromide 15 mg), metoclopramide (as hydrochloride 10 mg) or placebo, in identical capsules, 60 min before ingesting 50 g lactose coloured with 1 g carmine dye (to measure gastrointestinal transit time). Gastrointestinal symptoms, urinary galactose excretion, and breath hydrogen and blood glucose concentrations were recorded. RESULTS: The propantheline-induced prolongation of gastric emptying improved tolerance to lactose, as measured by reduced area under the gastrointestinal symptom score curve 0-12 h, compared to placebo (by 26%) (P < 0.05) or metoclopramide (by 30%) (P < 0.05). The total hydrogen excretion AUC (180 min follow-up) increased by 15% after metoclopramide as compared with placebo (P = 0.18). Propantheline decreased this variable by 15% from placebo (P = 0.17). No significant differences in blood glucose, urinary galactose or gastrointestinal transit time were found. CONCLUSIONS: In an oral lactose tolerance test, delaying gastric emptying with propantheline improved tolerance in lactose maldigesters, as measured by diminished gastrointestinal symptoms and reduced breath hydrogen concentration.
Adult↗
A study of lactose absorption capacity in twins.
Lactose absorption capacity was determined by lactose tolerance tests with breath hydrogen determination in 102 healthy, adult, Hungarian pairs of twins in order to test monogenic Mendelian inheritance of the absorptive lactase phenotypes, lactose absorber and lactose malabsorber. Of the total, 52 pairs were monozygous (MZ) and 50 dizygous (DZ) twins of identical sex. All MZ twins were concordant with respect to lactase phenotype. Among DZ twins, the distribution of lactase phenotypes was in agreement with Hardy-Weinberg expectations derived from the frequencies of the hypolactasia gene in DZ and MZ twins, and in the general Budapest population. In the second part of the study, three commonly used methods of lactose tolerance testing, the blood glucose, the blood galactose, and the breath hydrogen tests, were compared in 49 pairs of twins concordant for lactase phenotype. Blood galactose concentration showed the greatest and only significant difference between the intrapair correlation coefficients of MZ and DZ, and no overlap between lactose absorbers and lactose malabsorbers. The intrapair correlation coefficients of peak breath hydrogen concentration in MZ and DZ twins did not significantly differ from zero, but the resolution of lactase phenotypes was satisfactory. Differences in glucose absorption and concentration in lactose absorbers and malobsorbers overlapped considerably, and among lactose absorbers correlation coefficients in DZ were higher than in MZ twins. In MZ and DZ twins, the difference in concordance and constancy of lactose intolerance symptoms was not significant.
Adolescent↗