From the Guidelines
The most appropriate initial step in the workup for lactose intolerance is hydrogen breath testing, if available, or withdrawal of dietary lactose/carbohydrates from the diet, as recommended by the British Society of Gastroenterology guidelines 1. When suspecting lactose maldigestion, it is crucial to consider the most recent and highest quality evidence. The guidelines from 2018 suggest that hydrogen breath testing is a suitable method for diagnosing lactose intolerance, with the alternative being the withdrawal of dietary lactose/carbohydrates from the diet. Some key points to consider in the workup for lactose intolerance include:
- Hydrogen breath testing is a reliable diagnostic method, but it may not be available in all settings.
- Withdrawal of dietary lactose/carbohydrates from the diet can be a practical diagnostic approach, especially in primary care settings.
- Other diagnostic methods, such as lactose tolerance tests or stool acidity tests, may also be considered, but they are not as strongly recommended by the guidelines.
- It is essential to consider secondary causes of lactose intolerance, including celiac disease, inflammatory bowel disease, or small intestinal bacterial overgrowth. The British Society of Gastroenterology guidelines provide a comprehensive approach to the investigation of chronic diarrhea, including lactose intolerance, and should be consulted for further guidance on diagnostic testing and management 1.
From the Research
Diagnostic Methods for Lactose Intolerance
- The diagnosis of lactose intolerance can be made using various methods, including genetic tests, hydrogen breath test (HBT), quick lactase test, and lactose tolerance test 2.
- HBT is the most commonly used method due to its non-invasive nature, low cost, and high sensitivity and specificity 2.
- Other diagnostic investigations available include endoscopic and physiological tests 3, 4.
- The lactose hydrogen breath test is a non-invasive test that measures the amount of hydrogen in the breath, which is produced when undigested lactose is fermented by bacteria in the colon 5.
Symptoms and Management of Lactose Intolerance
- Symptoms of lactose intolerance include abdominal pain, bloating, flatulence, and diarrhea, with considerable variability in severity 2, 3, 4, 5.
- Management of lactose intolerance consists of two possible clinical choices: alimentary restriction and drug therapy, which are not mutually exclusive 5.
- Treatment options include a low-lactose diet, lactase supplementation, and potentially, colonic adaptation by prebiotics 4.
- Orally supplemented lactase enzyme has been shown to significantly reduce clinical symptoms and hydrogen breath excretion in patients with lactose intolerance 6.
Therapeutic Options for Lactose Intolerance
- An appropriate intervention for lactose intolerance concerns the dietetic style, such as the consumption of lactose-free foods with nutritional characteristics comparable to dairy products 2.
- Other valid choices include the use of exogenous enzymes, probiotics, prebiotics, and the selection of milk containing specific types of beta-caseins 2.
- A low FODMAP diet may be necessary for patients with irritable bowel syndrome (IBS) who also have lactose intolerance, as they may require restriction of not only lactose but also other fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) 3.