Lactose malabsorption and intolerance: a systematic review on the diagnostic value of gastrointestinal symptoms and self-reported milk intolerance.
BACKGROUND
When lactose malabsorption gives rise to symptoms, the result is called 'lactose intolerance'. Although lactose intolerance is often bothersome for patients, once recognized it may be managed by simple dietary adjustments. However, diagnosing lactose intolerance is not straightforward, especially in primary care.


OBJECTIVE
To summarize available evidence on the diagnostic performance of gastrointestinal symptoms and self-reported milk (lactose) intolerance in primary care, and the relationship between lactose malabsorption and intolerance.


METHODS
PubMed, EMBASE and reference screening.


METHODS
Studies were selected if the design was a primary diagnostic study; the patients were adults consulting because of non-acute abdominal symptoms; the diagnostic test included gastrointestinal symptoms and/or self-reported milk intolerance. A total of 26 primary diagnostic studies were included in the review.


METHODS
Quality assessment and data extraction were performed by two reviewers independently. They adhered to the most recent guidelines for conducting a diagnostic review as described in the Cochrane Diagnostic Reviewers' Handbook.


RESULTS
The diagnostic performance of diarrhea, abdominal pain, bloating, flatulence and self-reported milk intolerance was highly variable. A non-Caucasian ethnic origin was associated with the presence of lactose malabsorption. Both lactose malabsorbers and lactose absorbers reported symptoms during the lactose hydrogen breath test.


CONCLUSIONS
Our review shows that high-quality studies on the diagnosis of lactose malabsorption and intolerance in primary care are urgently needed. An important prerequisite would be to clearly define the concept of lactose intolerance, as well as how it should be assessed.
Jellema
P
P
Department of General Practice, EMGO Institute for Health and Care research, VU University Medical Centre and NIVEL (Netherlands Institute for Health Services Research), Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Schellevis
F G
FG
van der Windt
D A W M
DA
Kneepkens
C M F
CM
van der Horst
H E
HE
D059026:Diagnostic Self Evaluation; D006801:Humans; D007787:Lactose Intolerance / Q000175:diagnosis* / Q000523:psychology; D011237:Predictive Value of Tests; D012016:Reference Values; D012720:Severity of Illness Index