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. 1977 Oct;52(10):766–771. doi: 10.1136/adc.52.10.766

Lactose intolerance, detected by the hydrogen breath test, in infants and children with chronic diarrhoea

H V L Maffei, G Metz, V Bampoe, M Shiner, S Herman, C G D Brook
PMCID: PMC1544801  PMID: 931422

Abstract

Twenty-three infants and children aged 2½ months to 13 years with chronic diarrhoea and 6 patients without diarrhoea were investigated for lactose malabsorption with the hydrogen breath test (HBT) adapted for use in young infants and children. A further 8 children with proven or suspected coeliac disease were also investigated. The HBT was compared with the histology of the jejunal mucosa, mucosal lactase estimations, a lactose tolerance test, symptoms during the test, and follow-up after starting a lactose free diet.

The 6 patients without diarrhoea showed no evidence of hypolactasia and the hydrogen (H2)* concentration on the HBT was below 7 parts per million (ppm), a level considered to be clinically nonsignificant. 12 of the 23 patients with diarrhoea had a breath H2 concentration greater than 24 ppm and this correlated well with their clinical symptoms during or after the test and with the remission of the diarrhoea after lactose withdrawal. Of the remaining 11 patients with diarrhoea whose breath H2 concentration was lower than 25 ppm, symptoms did not improve when a lactose-free diet was started in 3, while a further 4 improved on a full diet.

There was poor correlation between the HBT and the findings on the jejunal mucosal specimens. All but one of the coeliac patients had an HBT less than 20 ppm and none of these required lactose withdrawal for remission of symptoms. The HBT is a noninvasive test particularly suitable for outpatients and it gives a useful prognostic guide to the efficacy of lactose-free diet in the treatment of chronic diarrhoea in children.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arthur A. B. Intestinal disaccharidase deficiency in children with coeliac disease. Arch Dis Child. 1966 Oct;41(219):519–524. doi: 10.1136/adc.41.219.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Asp N. G., Gudmand-Höyer E., Andersen B., Berg N. O., Dahlqvist A. Distribution of disaccharidases, alkaline phosphatase, and some intracellular enzymes along the human small intestine. Scand J Gastroenterol. 1975;10(6):647–651. [PubMed] [Google Scholar]
  3. Bond J. H., Jr, Levitt M. D. Use of pulmonary hydrogen (H 2 ) measurements to quantitate carbohydrate absorption. Study of partially gastrectomized patients. J Clin Invest. 1972 May;51(5):1219–1225. doi: 10.1172/JCI106916. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cook G. C. Lactase activity in newborn and infant Baganda. Br Med J. 1967 Mar 4;1(5539):527–530. doi: 10.1136/bmj.1.5539.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Harrison M., Walker-Smith J. A. Reinvestigation of lactose intolerant children: lack of correlation between continuing lactose intolerance and small intestinal morphology, disaccharidase activity, and lactose tolerance tests. Gut. 1977 Jan;18(1):48–52. doi: 10.1136/gut.18.1.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. KERRY K. R., ANDERSON C. M. A WARD TEST FOR SUGAR IN FAECES. Lancet. 1964 May 2;1(7340):981–981. doi: 10.1016/s0140-6736(64)91777-5. [DOI] [PubMed] [Google Scholar]
  7. Krasilnikoff P. A., Gudman-Hoyer E., Moltke H. H. Diagnostic value of disaccharide tolerance tests in children. Acta Paediatr Scand. 1975 Sep;64(5):693–698. doi: 10.1111/j.1651-2227.1975.tb03906.x. [DOI] [PubMed] [Google Scholar]
  8. Levin B., Abraham J. M., Burgess E. A., Wallis P. G. Congenital lactose malabsorption. Arch Dis Child. 1970 Apr;45(240):173–177. doi: 10.1136/adc.45.240.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Levitt M. D., Ingelfinger F. J. Hydrogen and methane production in man. Ann N Y Acad Sci. 1968 Feb 26;150(1):75–81. doi: 10.1111/j.1749-6632.1968.tb19033.x. [DOI] [PubMed] [Google Scholar]
  10. Levitt M. D. Production and excretion of hydrogen gas in man. N Engl J Med. 1969 Jul 17;281(3):122–127. doi: 10.1056/NEJM196907172810303. [DOI] [PubMed] [Google Scholar]
  11. Maffei H. V., Metz G. L., Jenkins D. J. Hydrogen breath test: Adaptation of a simple technique to infants and children. Lancet. 1976 May 22;1(7969):1110–1111. doi: 10.1016/s0140-6736(76)90069-6. [DOI] [PubMed] [Google Scholar]
  12. Metz G., Gassull M. A., Drasar B. S., Jenkins D. J., Blendis L. M. Breath-hydrogen test for small-intestinal bacterial colonisation. Lancet. 1976 Mar 27;1(7961):668–669. doi: 10.1016/s0140-6736(76)92779-3. [DOI] [PubMed] [Google Scholar]
  13. Metz G., Gassull M. A., Leeds A. R., Blendis L. M., Jenkins D. J. A simple method of measuring breath hydrogen in carbohydrate malabsorption by end-expiratory sampling. Clin Sci Mol Med. 1976 Mar;50(3):237–240. doi: 10.1042/cs0500237. [DOI] [PubMed] [Google Scholar]
  14. Metz G., Jenkins D. J., Newman A., Blends L. M. Breath hydrogen in hyposucrasia. Lancet. 1976 Jan 17;1(7951):119–120. doi: 10.1016/s0140-6736(76)93157-3. [DOI] [PubMed] [Google Scholar]
  15. Newcomer A. D., McGill D. B. Lactose tolerance tests in adults with normal lactase activity. Gastroenterology. 1966 Mar;50(3):340–346. [PubMed] [Google Scholar]
  16. Newcomer A. D., McGill D. B., Thomas P. J., Hofmann A. F. Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med. 1975 Dec 11;293(24):1232–1236. doi: 10.1056/NEJM197512112932405. [DOI] [PubMed] [Google Scholar]
  17. PLOTKIN G. R., ISSELBACHER K. J. SECONDARY DISACCHARIDASE DEFICIENCY IN ADULT CELIAC DISEASE (NONTROPICAL SPRUE) AND OTHER MALABSORPTION STATES. N Engl J Med. 1964 Nov 12;271:1033–1037. doi: 10.1056/NEJM196411122712003. [DOI] [PubMed] [Google Scholar]
  18. SUNSHINE P., KRETCHMER N. STUDIES OF SMALL INTESTINE DURING DEVELOPMENT. III. INFANTILE DIARRHEA ASSOCIATED WITH INTOLERANCE TO DISACCHARIDES. Pediatrics. 1964 Jul;34:38–50. [PubMed] [Google Scholar]
  19. Solomons N. W., Viteli F. Breath hydrogen during sleep. Lancet. 1976 Sep 18;2(7986):636–636. doi: 10.1016/s0140-6736(76)90707-8. [DOI] [PubMed] [Google Scholar]

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