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Objectives  Lactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H 2 B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H 2 B concentrations.    Methods  A total of 430 patients (40 years, Q1–Q3 = 28–54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively.    Results  H 2 B was  20 ppm in 15.8% of subjects. In patients with H 2 B &lt;20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=−0.389; p&lt;0.05). The increase in glycemia during LTT was not influenced by H 2 B levels obtained in HBT.    Conclusions  LTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H 2 B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.

Lactose tolerance test as an alternative to hydrogen breath test in the study of lactose malabsorption