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Aims: To evaluate whether orocoecal transit time (OCTT) might improve the correct allocation (lactose absorb- ers vs malabsorbers) of subjects with "borderline" H2 Breath test (H2BT) values ranging 10-20 ppm, and to determine among malabsorbers if OCTT can aid to discern lactose intolerant from tolerant individuals. Patients and Methods: OCTT and increment of H2 levels in breath following a dose of lactose were assessed in 49 chil- dren (mean age 3.3 years; range 0.6-11.0) suspected of lactose malabsorption. A rise > 20 ppm was used as the criterion to separate malabsorbers from absorbers. Results: OCTT averaged 177 ± 40 minutes (mean ± SD) in 14 H2 producing lactose absorbers and 78 ± 39 minutes in 22 lactose malabsorbers (p 75 minutes and no lactose tolerant subject had an OCTT < 75 minutes (sensitivity and specificity 100%; PPV and NPV 100%). Values between 105 and 175 minutes represented a gray area including both absorbers (21%) and all tolerant malabsorb- ers (100%). OCTT longer than 175 minutes excluded lactose malabsorption (sensitivity 100%; specificity 69%; PPV 84%; NPV 100%). In 6 out of 8 cases with borderline H2BT results, OCTT clear cut values were useful to reach the cor- rect diagnostic allocation. Conclusions: OCTT evaluation in addition to considering only H2 concentration is a methodological improvement of H2BT procedure. Although it does not represent an absolute gold standard, OCTT testing may aid in reaching a diagnostic conclusion in some patients where clinical and laboratory features after lactose ingestion remains unclear.

Time Course of H2 Production Following Oral Lactose Load in Children with and without Lactose Intolerance