Lactose intolerance: analysis of underlying factors

BACKGROUND: We studied the degree of lactose digestion and orocecal transit time (OCTT) as possible causes for the variability of symptoms of lactose intolerance (LI) in a sample of a population with genetically determined low lactase activity. METHODS: Lactose digestion index (LDI) was measured by the recently developed 13C-lactose/2H-glucose test. The OCTT was determined using the breath hydrogen test. Based on a 6-h symptom score (SSC) after a challenge dose of 25 g of lactose the subjects were divided into a tolerant group (T: n= 15; SSC = 0) and an intolerant group (IT: n= 28; SSC 1-40). The intolerant group was subdivided according to the severity of symptoms: group ITa (n = 17; mild symptoms without diarrhoea) and group ITb (n = 11; with diarrhoea). RESULTS: The LDI was lower in the intolerant group (0.34 +/- 0.14) (mean +/- SD) than in the tolerant group (0.47 +/- 0.14) (P = 0.008). The OCTT of group IT (60, 30-90 min) (median, quartiles) was significantly shorter than that of group T (105, 60-120 min) (P = 0.003) and was positively correlated with the LDI (P = 0.050). In groups ITa and ITb the OCTT (60, 30-90 min; 60, 26-83 min) and LDI (0.30 +/- 0.14; 0.39 +/- 0.14) were similar. CONCLUSIONS: Lactose digestion capacity, which is determined by small intestinal lactase activity as well as by OCTT, affects the occurrence of lactose intolerance. However, the major difference in intolerance symptoms is caused by differences in the colonic processing of maldigested lactose.     

轮状病毒感染与继发婴幼儿乳糖不耐受的相关分析

目的评价尿半乳糖检测在轮状病毒感染引起的婴幼儿腹泻中的应用价值。方法天津市儿童医院2013年1月1日至12月31日收治的轮状病毒感染患儿210例纳入轮状病毒感染腹泻组,另48例细菌感染腹泻患儿纳入细菌感染性腹泻组,47例症状性腹泻患儿纳入症状性腹泻组。3组患儿均进行尿半乳糖检测,并比较3组患儿乳糖不耐受阳性率。分析210例轮状病毒感染患儿的季节分布情况。结果轮状病毒主要侵犯1岁以下婴幼儿,且全年均有感染发生,尤其好发于11~12月,轮状病毒腹泻患儿并发乳糖不耐受阳性率高于细菌感染性腹泻组和症状性腹泻组(P<0.05)。结论轮状病毒感染性腹泻患儿应及早做尿半乳糖检测,及时停饮母乳或牛乳,采用去(或低)乳糖饮食,以免延误病情。     

继发性乳糖不耐受症与轮状病毒性肠炎的关系分析

目的探讨轮状病毒性肠炎与继发性乳糖不耐受的关系。方法对200例轮状病毒性肠炎患儿用醋酸铅加氢氧化氨法检测粪乳糖、pH值。粪乳糖大于或等于++,pH<5.5为乳糖不耐受症,将200例患儿分为治疗Ⅰ组及治疗Ⅱ组,粪乳糖阴性为对照组。结果 200例轮状病毒性肠炎中粪乳糖大于或等于++,pH<5.5,138例,其中年龄小于或等于6个月32例,≤1岁68例,≤2岁36例,≤3岁2例。治疗Ⅰ组及治疗Ⅱ组临床症状与对照组比较差异有统计学意义(P<0.01),治疗Ⅰ组与对照组疗效比较差异无统计学意义(P>0.05),治疗Ⅱ组与对照组疗效比较差异有统计学意义(P<0.01)。结论轮状病毒性肠炎容易导致继发乳糖不耐受症,且年龄越小,越容易发生继发性乳糖不耐受症,去乳糖饮食治疗轮状病毒性肠炎继发性乳糖不耐受症疗效显著,对轮状病毒性肠炎患儿应检测粪乳糖及pH,及早发现继发性乳糖不耐受症。     

Effect of lactose on oro-cecal transit in lactose digesters and maldigesters

BACKGROUND: The transit time of the small intestine, in addition to lactase activity, may influence lactose digestion and thus play a role in the occurrence of lactose intolerance. The objectives of this study were to investigate the effect of lactose on the oro-cecal transit time (OCTT) in lactose digesters and maldigesters as well as the possible mechanisms underlying these effects. MATERIALS AND METHODS: Twenty-eight Chinese subjects and 16 Dutch subjects underwent one glucose and one lactose challenge in two single-blinded tests. Twenty of the Chinese subjects without complaints after the challenge then underwent another lactose challenge. A 6-h symptom score (SSC) was recorded, breath-hydrogen concentration was measured and OCTT after consumption of glucose and lactose was determined with the lactose-[13C] ureide breath test. The lactose digestion index (LDI) was determined in both the Dutch and 20 Chinese subjects with the 13C/2H-glucose test. RESULTS: Lactose digesters (n = 13) and maldigesters (n = 20) were classified based on the results of the LDI and the breath-hydrogen test. The OCTT after the lactose and glucose challenges did not differ in the digesters, whereas in the maldigesters the OCTT, after the lactose challenge, was shorter than that after glucose. There was no difference in OCTT after the glucose challenge between the maldigesters and the digesters. However, the OCTT after the lactose challenge in the maldigesters was shorter than that in the digesters. The LDI of the digesters was significantly higher than that of the maldigesters. The OCTT after the lactose challenge was not correlated to the LDI in the maldigesters nor in the digesters. Based on the SSC after the one glucose and two lactose challenges, a tolerant (n = 7) and an intolerant (n = 5) group were classified in the Chinese subjects. The two groups did not differ in their LDI or OCTT after the lactose challenge. The OCTT after the lactose challenge was not correlated to the SSC or the LDI. CONCLUSIONS: Lactose triggers a faster oro-cecal transit in lactose maldigesters, but not in digesters. However, this could not be explained by intestinal distension resulting from the osmotic load posed by maldigested lactose, and thus suggests a direct effect of lactose on intrinsic factors regulating intestinal motility.     

Respiratory excretion of hydrogen and methane in Italian subjects after ingestion of lactose and milk

Lactose malabsorption, by the breath hydrogen test, and lactose intolerance (presence of symptoms) were studied in twenty healthy Italian subjects after intake of 12.5, 25 and 50 g lactose, whole milk and low-lactose milk. A rise in respiratory concentration of hydrogen (greater than 20 ppm) (malabsorption) was found in fifteen subjects after 50 g lactose, in thirteen after 25 g and in seven after 12.5 g. Symptoms generally occurred in subjects presenting a rise in respiratory hydrogen excretion, but such a rise was often observed without symptoms. Thirteen subjects presented symptoms after 50 g lactose, but only three after 25 g and one after 12.5 g. Whole milk (500 ml) gave a lower incidence of lactose malabsorption than 25 g lactose (7/20 versus 13/20, P less than 0.05) and more subjects developed symptoms (7/20 versus 3/20, NS). Low-lactose milk produced no malabsorbers and one intolerant. Breath methane was detected constantly in seven subjects and in three on some of the days of observation. Respiratory methane excretion generally appeared to be unrelated to lactose ingestion.     

Drug intolerance in patients with idiopathic environmental intolerance syndrome

The increasing rate of the idiopathic environmental intolerance (IEI) has been observed for the last decade. The aim of this report was to analyse the allergic component of the disease in particular relation to drug intolerance. Six patients with diagnosed IEI showed a positive skin test reaction to several commonly used antibiotics, nonsteroidal anti-inflammatory drugs, myorelaxants, verapamil, etc. In three cases, the thorough diagnosis of sensitivity to anaesthetic agents enabled to perform necessary surgical treatment, in others - facilitated the proper treatment of headaches and hypertension. Symptoms related to allergy contributed to the deterioration of IEI. Thus, a consultation of IEI patients by an allergologist seems to be of a substantial importance.     

下消化道不适患者乳糖不耐受认知度的调查及对策

目的 了解下消化道不适患者对乳糖不耐受的认知度.方法 自行设计调查问卷,对250例患者进行乳糖不耐受的相关知识调查,并对饮牛奶后出现消化道不适症状者进行产生症状的原因调查.结果 3.6%患者知道乳糖不耐受症状,118例饮奶后出现不适患者中78.8%认为产生症状的原因是自身胃肠道功能不好.结论 下消化道不适患者对乳糖不耐...     

Efficacy of incremental loads of cow’s milk as a treatment for lactose malabsorption in Japan

BACKGROUNDLactose intolerance (LI) is commonly seen in East Asian countries. Several studies showed that lactose or milk loading has been used as a treatment for lactose malabsorption (LM) in Western countries, but there have been no reports regarding this type of treatment in Japan. As lactose or milk loading requires ingestion of large amounts of lactose within a short period, this is considered to be too harsh for Japanese people because of their less habitual milk consumption (175 mL per day in average) than Western people. In this study, we demonstrated lactose tolerance acquisition in a suitable way for Japanese.AIMTo examine the efficacy of lactose (cow’s milk) loading treatment in patients with LM.METHODSIndividuals with abdominal symptoms induced by milk or dairy products (LI symptoms) were identified with a questionnaire. A 20 g lactose hydrogen breath test (LHBT) was carried out to confirm LM diagnosis and to evaluate co-existence of small intestinal bacterial overgrowth (SIBO). Respondents diagnosed with LM were selected as study subjects and were treated with incremental loads of cow’s milk, starting from 30 mL and increasing up to 200 mL at 4-7 d intervals. After the treatment, changes in symptoms and LM diagnostic value of 20 g LHBT were investigated. Stool samples pre- and post-treatment were examined for changes in intestinal microbiota using 16S rRNA sequencing. Informed consent was obtained prior to each stage of the study.RESULTSIn 46 subjects with LI symptoms (10-68 years old, mean age 34 years old) identified with the questionnaire, 35 (76.1%) were diagnosed with LM by 20 g LHBT, and 6 had co-existing SIBO. The treatment with incremental cow’s milk was carried out in 32 subjects diagnosed with LM (14-68 years old, median age 38.5 years old). The mean period of the treatment was 41 ± 8.6 d. Improvement of symptoms was observed in 29 (90.6%; 95% confidence interval: 75.0%-98.0 %) subjects. Although 20 g LHBT indicated that 10 (34.5%) subjects had improved diagnostic value of LM, no change was observed in 16 (55.2%) subjects. Analysis of the fecal intestinal microbiota showed a significant increase in Blautia in 7 subjects who became symptom-free after the treatment (P = 0.0313).CONCLUSIONLM was diagnosed in approximately 75% of the subjects who had LI. Incremental loads of cow’s milk is regarded as a useful treatment for LM without affecting everyday life.     

The 13C/2H-glucose test for determination of small intestinal lactase activity

To diagnose hypolactasia, determination of lactase enzyme activity in small intestinal biopsy material is considered to be the golden standard. Because of its strongly invasive character and the sampling problems, alternative methods have been looked for. We analysed the 13C-glucose response in serum after consumption of 25 g of naturally enriched 13C-lactose. As an internal standard, 0.5 g of 2H-glucose was added and the 2H-glucose response in serum was measured simultaneously. The studies were performed in healthy volunteers with a background of genetically determined lactase nonpersistence (n = 12; low lactase activity) and lactase persistence (n = 27; high lactase activity). The results were compared with those of the lactose hydrogen breath test, the lactose 13CO2 breath test and the previously described 13C-lactose digestion test. After consumption of 13C-lactose and 2H-glucose, the mean ratio 13C-glucose/2H-glucose concentration in serum at 45-75 min was 0.26 +/- 0.09 in the low lactase activity group and 0.93 +/- 0.17 in the high lactase activity group (P < 0.01). Threshold of the ratio between digesters and maldigesters was calculated as 0.46. Accuracy of the new test was superior to all other tests. We conclude that the 13C/2H-glucose test has the potential of determining the small intestinal lactase activity in vivo and of estimating the amount of lactose which is digested in the small intestine.     

河南地区442例儿童食物不耐受临床分析

目的分析河南地区442例儿童的食物不耐受情况,为临床饮食指导提供依据。方法选择442例行食物不耐受检测的儿童为研究对象,分析其食物不耐受情况。结果442例儿童中≥1种食物不耐受者395例(89.4%),其中1、2、3种食物不耐受者居多。儿童食物不耐受阳性及高度敏感集中在鸡蛋、牛奶两种食物。0~<3岁与3~6岁儿童的鸡蛋不耐受阳性率差异显著(P<0.05)。结论儿童食物不耐受发病率高,其中以牛奶、鸡蛋为主,根据检测结果可及时发现饮食中不适宜食物,并及时调整饮食有利儿童生长发育。     

超声在儿童结肠息肉诊断中的应用价值

目的探讨超声对儿童结肠息肉的诊断价值及其超声声像图特征。方法回顾性分析342例术前进行超声检查并经结肠镜及病理证实的结肠息肉患儿的超声表现。结果 342例患儿中男244例,女98例。224例(65.5%)患儿发病年龄为3～6岁。单发息肉333例,位于乙状结肠226例,直肠41例,余段结肠66例。多发息肉9例,共33枚。息肉最大5.3cm×1.7cm×3.1cm,最小0.6cm×0.5cm×0.5cm。超声诊断332例(97.1%),超声表现均为中等回声结节,其内部可探及小囊腔且CDFI血供丰富,可探及蒂血流及息肉内部树枝状血流。<1cm的息肉囊腔及蒂结构不明显,但CDFI可探及明确的血流信号。16例患儿超声检出合并继发肠套叠,表现为同心圆征象,套入起始部肠腔内可探及息肉回声。其中14例患儿息肉位于降结肠及结肠脾曲。结论超声诊断儿童结肠息肉方便、无创、无放射性且检出率高,是血便患儿首选检查方法。结肠息肉超声声像图具有特异性,不易与其他病变混淆,在儿童一般不需鉴别诊断。     

超声检查诊断小儿结肠息肉

目的 探讨超声检查对小儿结肠息肉的诊断价值。 方法 回顾性分析接受常规超声或结合生理盐水灌肠后超声检查的结肠息肉患儿46例,以结肠镜检查为金标准,对超声检出结肠息肉的敏感度进行统计学分析。 结果 结肠镜诊断结肠息肉患儿46例,其中单发息肉44例,2枚息肉2例;7枚息肉直径≤1 cm,38枚>1 cm且<3 cm者,3枚≥3 cm。超声诊断息肉患儿43例,其中单发息肉42例,2枚息肉1例;超声漏诊3例(4枚息肉)。超声检出息肉的总敏感度为91.67%(44/48),其中对直径>1 cm且<3 cm、≥3 cm息肉的敏感度分别为97.37%(37/38)、100%(3/3),明显高于直径≤1 cm的结肠息肉检出敏感度(4/7,57.14%)。 结论 超声检查具有安全、无创、简便等特点,可作为检查小儿结肠息肉的首选方法。     

食物不耐受血清特异性IgG抗体检测在临床中的应用

目的 探讨血清中14种食物不耐受特异性IgG抗体与临床疾病的关系,为临床提供诊治相关疾病的依据.方法 应用酶联免疫法检测110例临床常见慢性疾病患者及30例健康人血清中食物特异性IgG水平.结果 人群中食物不耐受特异性IgG升高均有1～8种不等,总阳性率为100%,顺序为:牛奶＞小麦＞螃蟹＞鸡蛋＞虾米＞鳕鱼＞大豆＞牛肉＞猪肉＞大米＞鸡肉＞玉米＞蘑菇＞番茄.根据试验结果调整所有患者的饮食,患者症状多可以明显改善.结论 测定食物不耐受特异性IgG抗体,并尽早将阳性食物从患者食谱中去除,在临床疾病诊治中有重要意义.     

小儿慢性迁延性腹泻与食物不耐受的相关性分析

目的通过检测并对比慢性迁延性腹泻病患儿与健康体检儿童血清中食物特异性IgG抗体的水平,分析小儿慢性迁延性腹泻病的发生与食物不耐受是否具有相关性。方法随机抽取深圳市儿童医院2015年1-12月临床诊断为慢性迁延性腹泻病的患儿105例,并选取健康体检儿童94例作为对照组,采用酶联免疫法检测受检者血清中14种食物过敏原特异性IgG抗体的浓度水平。结果慢性迁延性腹泻病多见于0~1岁的小婴儿,105例慢性迁延性腹泻病患儿的14种食物特异性IgG抗体阳性率水平从高到低依次排列为:牛奶、鸡蛋、西红柿、大米、小麦、鳕鱼、玉米、牛肉、大豆、鸡肉、猪肉、蘑菇、虾和蟹;94例健康体检儿童的14种食物特异性IgG抗体阳性率水平从高到低依次排列为:牛奶、鸡蛋、西红柿、大米、小麦、大豆、鳕鱼、玉米、牛肉、蟹、鸡肉、蘑菇、虾和猪肉;其中牛奶、牛肉和大豆的食物特异性IgG在两组间的比较中具有统计学意义(P0.05)。结论食物不耐受有可能是婴幼儿发生慢性迁延性腹泻病的重要病因之一,可以通过合理调整小儿饮食治疗小儿慢性迁延性腹泻病。     

彩色多普勒超声检查在诊断肠息肉引起的小儿继发性肠套叠中的价值研究

目的 探讨超声在诊断肠息肉引起的小儿继发性肠套叠中的价值,并总结其声像图的特点,为临床治疗方式的选择提供依据。 方法 本文回顾性分析我院2010年1月至2017年5月肠息肉致肠套叠患儿36例,均进行使用彩色多普勒超声低频和高频探头进行腹部扫查,分析其临床表现、超声图像、治疗及预后。结果 36例患儿年龄1月至11岁,临床症状主要包括阵发性哭吵、腹痛、血便及呕吐。36例患儿均具有肠套叠的典型超声声像图表现,即短轴呈“同心圆”征,长轴呈“假肾”征,超声诊断结果与临床诊断一致;其中10例(27.8％)超声诊断出息肉病变,声像图表现为在套头内或套头边缘发现实质性病变,为中等回声,CDFI可见丰富的放射状血流信号,明确诊断后,临床采用空气灌肠后行电子肠镜息肉切除术,顺利恢复出院;仍有26例患儿超声仅发现肠套叠征象,行空气灌肠后又复发肠套叠,23例(63.9％)患儿行剖腹探查及肠息肉切除术,3例(8.3％)患儿行剖腹探查及肠切除肠吻合术。结论 彩色多普勒超声检查诊断小儿肠套叠的敏感性和特异性极高,在对于肠息肉引起的小儿继发性肠套叠的诊断中,能发现息肉明确病因,指导治疗方式的选择。     

结肠癌并发急性肠梗阻的外科处理

目的　探讨结肠癌并发急性肠梗阻的外科处理。方法　分析 1995～ 2 0 0 3年间 5 3例结肠癌致急性肠梗阻的外科治疗资料。结果　 5 3例患者中Ⅰ期切除吻合 4 7例 (88 6 8% ) ,其中右半结肠 8例。横结肠 4例 ,左半结肠 12例 ,乙状结肠 2 3例。 4例Ⅰ期肿瘤切除 ,结肠造瘘 ,Ⅱ期肠吻合术。 2例行永久性结肠双腔造口术。术后并发症发生率 13 2 % (7/5 3) ,围手术期病死率 1 9% (1/5 3)。结论　重视对结肠癌致肠梗阻的认识 ,及时诊断 ,做好围术期处理 ,合理选择手术方式是减少并发症和提高疗效的关键。     

福州地区1382例体检者14种食物不耐受情况的分析

目的分析福州地区人群对14种食物不耐受情况。方法采用酶联免疫吸附试验（EuSA）法半定量检测血清中14种食物不耐受血清特异性IgG抗体。结果在1382例人群中,14种食物不耐受率最低的是猪肉（0．00％）,最高的是蛋清／蛋黄（31．19％）。其中女性的螃蟹、鳕鱼、大豆阳性率均高于男性,男性的玉米阳性率则高于女性,差异均有统计学意义（P〈0．05）。另外中年组的蛋黄／蛋清、牛奶、大豆、大米、玉米、小麦阳性率均低于青年组,差异有统计学意义（P〈0．05）。中年组与老年组的蛋黄/蛋清、大豆阳性率比较,差异有统计学意义（P〈0．05）。结论普通人群中存在不同程度的食物不耐受,为降低对某些食物的不耐受,可根据性别、年龄和地区的差异做好健康宫教工作。     

泉州地区联合糖耐量异常人群饮食状况的调查研究

目的 通过对泉州地区CGI人群的饮食状况进行调查,为饮食治疗干预CGI提供有针对性的指导.方法 对84例CGI的一般情况、饮食情况、劳动强度情况、体质量情况和热量情况进行问卷调查后进行统计学分析.结果 泉州地区CGI人群饮食总热量不足和过多同时存在,三大营养素摄入比例不合理问题突出,表现为碳水化合物比例过低,蛋白质偏高,脂肪较高.热量控制与患者年龄、文化程度、睡前加餐热量比呈正相关,与碳水化合物比例、脂肪比例,退休与否、在外就餐与否、在外就餐频率、每天食用油量、每天蔬菜食用量有关,超重者的饮食控制问题较为突出.结论 要加强对泉州地区CGI人群的饮食控制进行教育.     

早产儿喂养不耐受的相关因素分析

目的:探讨早产儿喂养不耐受的相关因素,为降低不耐受发生率提前采取措施。方法:对134例早产儿的喂养不耐受发生率进行统计,并对性别、孕产史、胎龄等19项因素与喂养耐受情况作回归分析,找出喂养不耐受的危险因素。结果:早产儿喂养不耐受发生率为47.8%;出生体重BW>2500g、2000g34周、32周相似文献   

梗阻性左半结肠癌术中无灌洗一期切除吻合的应用

目的 探讨术中无灌洗一期切除吻合在梗阻性左半结肠癌手术中的应用价值.方法 回顾性分析首都医科大学宣武医院普外科2000年1月至2008年1月收治的一期手术切除吻合左半结肠癌患者93例,无梗阻的左半结肠癌患者50例,行左半结肠切除术;梗阻性左半结肠癌患者43例,行无灌洗的术中排便一期切除吻合.两组患者在性别、营养状态、基础疾病、肿瘤部位、分期等方面差异无统计学意义(P>0.05).梗阻性结肠癌患者年龄(61.2±8.6)岁,明显大于无梗阻患者的年龄(58.1±7.8)岁(P<0.05).比较结肠梗阻和无梗阻患者的手术治疗效果.结果 在93例患者中,无梗阻结肠癌患者住院时间为(12.4±5.4)d,术中排便一期切除吻合患者平均住院时间为(16.6±7.8)d,前者住院时间明显小于后者(P<0.01).梗阻性结肠癌术中排便一期手术患者的平均住院费用为(50192.8±39727.4)元,无梗阻结肠癌患者平均费用为(46489.3±29543.1)元,两组存在显著性差异(P<0.05).无灌洗术中排便一期手术患者和无梗阻左半结肠切除患者的并发症分别为25.6%(11/43)、18%(9/50)(P<0.05),病死率分别为2.3%(1/43)、2.0%(1/50)(P>0.05),无显著性差异.结论 无灌洗的术中排便一期切除吻合是左半结肠癌肠梗阻的可行手术方式,与无梗阻结肠癌的手术效果相似.