title: Lactose malabsorption diagnosed by 50-g dose is inferior to assess clinical intolerance and to predict response to milk withdrawal than 25-g dose in an endemic area.
abstract: BACKGROUND
  Lactose malabsorption (LM), diagnosed currently using lactose hydrogen breath and tolerance tests (LHBT, LTT) with a high, nonphysiological dose (50-g), may mimic irritable bowel syndrome (IBS). In LM-endemic areas, clinically significant malabsorption (lactose intolerance) may be better diagnosed using a lesser dose, and positive results so obtained may predict response to milk withdrawal more effectively.
  
  
  METHODS
  Fifty patients each with IBS (Rome III) were evaluated using LHBT and LTT with 50-g, 25-g, and 12-g lactose. Sensitivity and specificity of LHBT and LTT with different dosages (gold standard: lactase gene C/T-13910 polymorphism) and symptom development were evaluated. Effect of milk withdrawal was studied.
  
  
  RESULTS
  Of 150 patients, 37/50 (74%) and 28/50 (56%) had LM by LHBT and LTT using 50-g lactose; 41/50 (82%) and 31/50 (62%) had LM using 25-g lactose, and 14/50 (28%) and 29/50 (58%) using 12-g lactose, respectively. Sensitivity and specificity of LHBT using 50-g, 25-g, and 12-g lactose were 92.6%, 52.0%, and 94%, 60%, and 36.4%, 88.2%, and those of LTT, 92%, 80.0%, and 84.8%, 82.4%, and 66.7%, 58.8%, respectively. Breath hydrogen correlated with lactose dose. Though patients developing symptoms with 50-g lactose exhaled more hydrogen than those remaining asymptomatic, hydrogen levels did not differ following 25-g and 12-g dosages in relation to symptom development. Patients' milk intake was 335 ± 92 mL/d (≈ 16.7 ± 9.6-g lactose). Positive LHBT using 25-g dose better predicted symptom resolution than by 50-g and 12-g lactose.
  
  
  CONCLUSIONS
  Twenty-five gram is the ideal dose of lactose for LHBT and LTT in LM-endemic areas.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Asha
authors.initials: A
authors.lastname: Misra
authors.forename: Balraj
authors.initials: B
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000818:Animals; D001944:Breath Tests / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000178:diet therapy / Q000235:genetics; D010694:Lactase-Phlorizin Hydrolase / Q000235:genetics; D007785:Lactose / Q000008:administration & dosage*; D007787:Lactose Intolerance / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy / Q000235:genetics; D008297:Male; D008875:Middle Aged; D008892:Milk; D011110:Polymorphism, Genetic; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D006859:Hydrogen; D010694:Lactase-Phlorizin Hydrolase; D007785:Lactose
keywords: abdominal bloating; chronic diarrhea; functional bowel disease; lactose malabsorption; milk intolerance