Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet.
OBJECTIVE
In a recent study by our group, it was shown that a large proportion of patients with lactose malabsorption and with no bacterial overgrowth are affected by silent coeliac disease (CD). Our aim was to evaluate the effect of a gluten-free diet on lactose malabsorption assessed using the hydrogen lactose breath test (LBT) and also the relationship with normalization of duodenal biopsies in coeliac patients.


METHODS
Fifteen patients (11 F, 4 M; mean age 35.8+/-6) affected by CD with a positive LBT and negative glucose breath test were enrolled. All were started on a gluten-free diet and were re-evaluated after 6 months by LBT and after 12 months by both LBT and upper gastrointestinal endoscopy with biopsies.


RESULTS
LBT normalization was observed in 1 out of 15 patients (6.7%) after 6 months and in 9 of the remaining 14 (64.2%) after 12 months. Duodenal biopsies showed normal villi in 8 patients, partial villous atrophy in 5 and total atrophy in 2.


CONCLUSIONS
The present study shows that a large proportion of CD patients experience a regression of lactose malabsorption after receiving a gluten-free diet. This may be related to normalization of the brush border with an improvement of lactase enzyme activity. LBT should be performed after 12 months in CD patients on a gluten-free diet in order to assess the persistence/disappearance of lactose malabsorption, thus avoiding an unnecessary lactose-free diet.
Ojetti
Veronica
V
Internal Medicine Catholic University, Rome, Italy. veronica.ojetti@tin.it
Gabrielli
Maurizio
M
Migneco
Alessio
A
Lauritano
Cristiano
C
Zocco
Maria Assunta
MA
Scarpellini
Emidio
E
Nista
Enrico Celestino
EC
Gasbarrini
Giovanni
G
Gasbarrini
Antonio
A
D000328:Adult; D001284:Atrophy; D001706:Biopsy; D001944:Breath Tests; D002446:Celiac Disease / Q000178:diet therapy* / Q000378:metabolism* / Q000473:pathology; D004386:Duodenum / Q000378:metabolism / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D005983:Glutens / Q000008:administration & dosage; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D007413:Intestinal Mucosa / Q000201:enzymology / Q000473:pathology; D043322:Lactase / Q000378:metabolism; D007785:Lactose / Q000493:pharmacokinetics; D008286:Malabsorption Syndromes / Q000178:diet therapy* / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008871:Microvilli / Q000201:enzymology / Q000473:pathology; D012044:Regression Analysis
D006859:Hydrogen; D005983:Glutens; D043322:Lactase; D007785:Lactose