Development, validation, and applicability of a symptoms questionnaire for lactose malabsorption screening.
Lactase deficiency has a high prevalence worldwide. Thus, a valid symptom scale would be a useful tool for identifying patients with lactose malabsorption.


OBJECTIVE
To develop, validate, and apply a symptoms questionnaire on lactose malabsorption to identify lactose malabsorbers diagnosed with the gold-standard hydrogen breath test.


METHODS
In the first part of the study, 292 patients completed a questionnaire at the end of a 50-g lactose breath test. The questionnaire included five items (diarrhea, abdominal cramping, vomiting, audible bowel sounds, and flatulence or gas) scored on a 10-cm visual analogue scale. In the second part of the study, 171 patients completed the questionnaire twice: first, according to their opinion when consuming dairy products at home and second, after a 50-g lactose breath test. Patients were grouped as absorbers or malabsorbers according to the result of the breath test.


RESULTS
Diarrhea, abdominal cramping, and flatulence were scored significantly higher in malabsorbers than in absorbers. Total score of the symptomatic questionnaire was significantly higher in malabsorbers (17.5 versus 3.0, P<0.01). According to receiver operator characteristics (ROC) analysis, the most discriminant cut-off of the total score to identify lactose malabsorption was 6.5 (sensitivity 0.75, specificity 0.67). In 58 malabsorbers the effect size of the questionnaire to determine sensitivity to change was 1.32. In the second part of the study, scoring of the home questionnaire was higher than after the lactose-breath test. The lactose malabsorbers rate was higher according to the home questionnaire than after the lactose breath test (72% versus 52%). The home questionnaire had excellent sensitivity (0.82) but low specificity (0.35).


CONCLUSIONS
We developed and validated a five-item symptoms questionnaire for lactose malabsorption. This is a valid test that permits patients with a total score lower than 7 to be excluded from future studies.
Casellas
Francesc
F
Digestive System Research Unit, Hospital Universitari Vall d'Hebron, Pso. Vall d'Hebron 119, Barcelona 08035, Spain. fcasellas@vhebron.net
Varela
E
E
Aparici
A
A
Casaus
M
M
Rodríguez
P
P
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001944:Breath Tests; D003967:Diarrhea / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000209:etiology; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007787:Lactose Intolerance / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000209:etiology
D006859:Hydrogen