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Assessment of the influence of hydrogen nonexcretion on the usefulness of the hydrogen breath test and lactose tolerance test.

The recognition of hydrogen nonexcretion in up to 20% of tested subjects and the large ethnic differences in the prevalence of lactose malabsorption make it necessary to reassess the diagnostic usefulness of the lactose tolerance test and the hydrogen breath test. Both tests were performed in 83 consecutive patients with suspected lactose malabsorption who ingested 50 g lactose. On a separate day a hydrogen breath test was performed after 25 g lactulose. The prevalence of hydrogen nonexcretion was 18%. The diagnostic usefulness of hydrogen breath test was influenced both by the individual threshold for hydrogen excretion and the amount of malabsorbed lactose. In addition to baseline values, breath samples for hydrogen measurements have to be taken at 30, 60, 90, 180, and 240 minutes after ingestion of lactose. For the lactose tolerance test only one measurement of serum glucose at 30 minutes is needed in addition to the baseline measurement. The combination of both tests excludes the influence of hydrogen nonexcretion, but even if a combined diagnostic approach utilizing the lactose hydrogen breath test and lactose tolerance test is used, 6% of patients presenting with symptoms suggestive of lactose intolerance cannot be classified.

Adolescent

Blood glucose rise after lactose tolerance testing in infants.

Lactose tolerance tests are used clinically to screen children and infants. It is assumed that absorption of a lactose challenge in infants would occur in a predictable pattern prior to weaning. Twenty-one infants from 3 to 12 months of age were studied. The maximum blood glucose rise over fasting levels ranged from 11.0 to 62.0 mg/100 ml; the mean was 32.6 mg/100 ml. Six infants had a maximum rise of less than 20 mg/100 ml. Eleven infants (52%) had a maximum rise of greater than 30 mg/100 ml. Signs of intolerance were not noted in any subject. Weight and length were normally disturbed. Results indicate the variance in glucose rise existing within a population of infants growing normally and consuming milk. Gastric emptying, digestion, and absorption may influence the blood glucose rise after a lactose test. Established glucose levels used as an index to lactose absorption in older children and adults may not accurately reflect lactase activity in infants.

Blood Glucose

Rapid and portable methods of lactose tolerance test administration.

Abbreviated, portable methods of lactose tolerance test administration were investigated. Results obtained with the Ames Reflectance Meter/Dextrostix system for blood glucose determination during lactose tolerance testing were compared with those obtained from a standard method, the AutoAnalyzer. Subjects who had maximum blood glucose rises below 20 mg/100 ml were considered to have a flat lactose tolerance curve and were designated lactose nondigesters. Results of the two methods were very similar for determination of maximum rise in blood sugar over fasting level, for obtaining values of individual blood sugar determinations, and for diagnosis of lactose nondigesters. The effect of omission of the final blood sample on tolerance test results was examined. It was found that maximum rises in blood glucose occurred before the final sample in 31 of 35 cases on the AutoAnalyzer and in 26 of 27 cases on the Reflectance Meter. In no case did omission of the final sample change the results of the lactose tolerance test.

Adult

Reinvestigation of lactose intolerant children: lack of correlation between continuing lactose intolerance and small intestinal morphology, disaccharidase activity, and lactose tolerance tests.

Thirty children on a lactose-free diet aged from 2-38 months who had previously been diagnosed as having secondary lactose intolerance were reinvestigated on 32 occasions by an oral lactose tolerance test, small intestinal biopsy, and measurement of disaccharidase activity in order to detect the presence of continuing lactose intolerance before reintroduction of milk. No correlation was found between continuing lactose intolerance, as diagnosed by the development of watery stools containing excess reducing substances after an oral load of lactose, and maximum blood glucose rise during a lactose tolerance test, lactase levels, and small intestinal morphology.

Child, Preschool

Oral lactose tolerance test in foals: technique and normal values.

Oral lactose tolerance tests were evaluated in 25 healthy foals (principals) assigned to 4 groups of approximately 1 week, 4 weeks, 8 weeks, and 12 weeks of age. Lactose monohydrate (1 g/kg of body weight [in a 20% water solution]) was administered via nasogastric tube after a 4-hour fast. Plasma glucose concentrations were monitored before dosing (0 minutes) and sequentially for 300 minutes. Six control foals were given a volume of water equivalent to the volume of lactose monohydrate administered to principal foals. After oral lactose loading, mean plasma glucose concentrations of all principal foals increased from 99.76 mg/dl at 0 minutes to 176.80 mg/dl by 90 minutes. Peak increases in plasma glucose concentrations were attained by 8% of the foals (2 foals) at 30 minutes, 76% (19 foals) at 60 minutes, and 16% (4 foals) at 90 minutes. The mean plasma glucose concentration increase of principal foals, regardless of age or time of peaking, was 77.04 mg/dl. There was no significant (P greater than 0.05) difference in fasting plasma glucose concentrations (0 minutes) among the 4 groups of principal foals or between principal and control foals; however, there was a significant (P less than 0.05) difference in peak glucose concentrations between 1-week-old and 12-week-old principal foals, with the older foals having the higher concentrations. Mean plasma glucose concentrations of control foals decreased from 79.67 mg/dl at 0 minutes to 55.17 mg/dl by 180 minutes. The mean peak decrease in plasma glucose concentrations of control foals, regardless of time of peaking, was 24.50 mg/dl.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Improved accuracy of lactose tolerance test in children, using expired H2 measurement.

Expired hydrogen and blood glucose were measured during an oral lactose tolerance test in 163 children aged between 9 months and 14 years. Lactose malabsorption, defined as an abnormal increase in expired H2 during a lactose tolerance test, was found in 54 children. Of these, 30 were found to be lactose intolerant as the increased expired H2 was accompanied by clinical symptoms. The other 109 children, in whom there was no rise in expired H2, were assumed to have normal lactose absorption. In children with lactose intolerance the increase in expired H2 tended to occur earlier after lactose ingestion than in children with malabsorption. The mean value of the rise in blood glucose was 2.4 mmol/100 ml) in the lactose-tolerant children and 1.0 mmol/1 (18 mg/100 ml) in the lactose-intolerant ones. Although this difference is significant (p less than 0.001), the rise in blood glucose, in predicting the correct diagnosis, was wrong in 13% of cases in the lactose-tolerant group, and wrong in 37% in the lactose-intolerant group (95% confidence limits 9-19% and 22-53% respectively). It is concluded that a rise in blood glucose, whether or not of more that 1.2 mmol/1 (22mg/100 ml) is of little help in differentiating lactose tolerance from intolerance.

Adolescent

Reduced rate of breath hydrogen excretion with lactose tolerance tests in young children using whole milk.

On 14 occasions, 1.75 g/kg of body weight of lactose was given in whole milk to preschool children who had significant malabsorption with aqueous lactose solution. The volume of hydrogen excreted in the breath was less after the milk meal. Moreover, the hydrogen response to the nonabsorbable disaccharide, lactulose, was greater with aqueous, solution than with a liquid meal but their difference disappeared when metoclopramide was given with the lactulose: meal. The slower hydrogen production is attributed to slower intestinal delivery of lactose in meals; this phenomenon may account for clinical lactose tolerance often seen in children with demonstrated lactose malabsorption.

Animals