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Lactose tolerance despite hypolactasia in adult coeliac disease
Author(s) -
KERLIN PAUL,
WONG LAWRENCE
Publication year - 1987
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1987.tb00159.x
Subject(s) - coeliac disease , medicine , lactose , disaccharidase , gastroenterology , malabsorption , lactose intolerance , lactase , hydrogen breath test , disease , small intestine , breath test , biology , food science , helicobacter pylori
Although symptoms of milk intolerance are common in primary (genetically determined) hypolactasia it is a clinical impression that such symptoms are infrequent in adult patients with hypolactasia secondary to damage of the mucosa of the small intestine. This study was designed to determine whether a lactose (50 g) challenge is better tolerated by patients with coeliac disease and secondary hypolactasia than patients with primary hypolactasia. Based on intestinal histology and disaccharidase levels, three groups of adults were studied: controls ( n = 20), patients with primary hypolactasia ( n = 20) and patients with hypolactasia secondary to newly diagnosed coeliac disease ( n = 15). The response to a challenge with 50 g lactose was assessed by a score of five symptoms and breath hydrogen production. Despite an equivalent level of hypolactasia, symptoms affected fewer patients with coeliac disease (33%) than subjects with primary hypolactasia (90%). Further, a positive lactose breath hydrogen test was noted in all (100%) patients with primary hypolactasia but in only six (40%) of those patients with newly diagnosed coeliac disease. These results suggest the presence of a considerable absorptive reserve for lactose in the distal small bowel of many patients with coeliac disease.