Digestive Diseases and Sciences

, Volume 40, Issue 7, pp 1506–1510 | Cite as

Lactose maldigestion and recurrent abdominal pain in children

  • Rebecca B. Webster
  • Jack A. DiPalma
  • David A. Gremse
Intestinal Disorders, Inflammatory Bowel Disease, Immunology, and Microbiology


Our objectives were to evaluate children with recurrent abdominal pain for lactose maldigestion and to assess factors which might predict lactose absorption status. One hundred thirty-seven children were referred for specialty evaluation of recurrent abdominal pain of at least three months' duration. Study subjects were evaluated by history and physical examination, dietary interviews, hematologic and biochemical laboratory testing, stool parasite examination, and radiologic or endoscopic structural examinations, as indicated. Lactose hydrogen breath testing was performed after challenge with 1 g/kg lactose (10% aqueous solution). There were 53 males and 84 females, whose ages ranged from 6 to 18 years (9.64 ±2.9; mean±sd). Lactose maldigestion was detected in 33/137 patients (24%). The prevalence of abdominal pain, bloating, gas, flatulence, diarrhea, and constipation was similar in children with or without lactose maldigestion. The perception of symptoms related to the ingestion of dairy products was similar in both groups. No other clinical parameter predicted lactose maldigestion. However, children with lactose maldigestion had overall clinical improvement with a lactose-restricted diet. Clinical evaluation alone cannot adequately predict the presence of lactose maldigestion in children. Formal evaluation for lactose maldigestion using breath hydrogen testing methods should be considered in children with recurrent abdominal pain.

Key Words

lactose maldigestion lactose intolerance recurrent abdominal pain lactose breath hydrogen test 


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  1. 1.
    Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. Arch Dis Child 33:165–170, 1958Google Scholar
  2. 2.
    Parcel GS, Nader PR, Meyer MP: Adolescent health concerns, problems and patterns of utilization in a triethnic urban population. Pediatrics 60:157–164, 1977Google Scholar
  3. 3.
    Dodge JA: Recurrent abdominal pain in children. Br Med J 1:385–387, 1976Google Scholar
  4. 4.
    Apley J: The Child with Abdominal Pains. London, Blackwell Scientific Publications, 1975Google Scholar
  5. 5.
    Bain HW: Chronic vague abdominal pain in children. Pediatr Clin North Am 21:991–1000, 1974Google Scholar
  6. 6.
    Bury RG: A study of 111 children with recurrent abdominal pain. Aust Paediatr J 23:117–119, 1987Google Scholar
  7. 7.
    Barr RG, Levine MD, Watkins JB: Recurrent abdominal pain of childhood due to lactose intolerance. N Engl J Med 300:1449–1452, 1979Google Scholar
  8. 8.
    Lebenthal E, Rossi TM, Nord KS, Branski D: Recurrent abdominal pain and lactose absorption in children. Pediatrics 67:828–832, 1981Google Scholar
  9. 9.
    Wald A, Chandra R, Fisher SE, Gartner JC, Zitelli B: Lactose malabsorption in recurrent abdominal pain of childhood. J Pediatr 100:65–68, 1982Google Scholar
  10. 10.
    Warman KY: Dietary treatment of carbohydrate intolerance. Semin Pediatr Gastroenterol Nutr 2:9–14, 1991Google Scholar
  11. 11.
    DiPalma JA, Collins MS: Enzyme replacement for lactose malabsorption using beta-d-galactosidase. J Clin Gastroenterol 11:290–293, 1989Google Scholar
  12. 12.
    Lin MY, DiPalma JA, Martini MC, Gross CJ, Harlander SK, Savaiano DA: Comparative effects of exogenous lactase (β-galactosidase) preparations onin vivo lactose digestion. Dig Dis Sci 38:2022–2027, 1993Google Scholar
  13. 13.
    Medow MS, Thek KD, Newman LJ, Berezin S, Glassman MS, Schwarz SM: β-Galactosidase tablets in the treatment of lactose intolerance in pediatrics. Am J Dis Child 144:1261–1264, 1990Google Scholar
  14. 14.
    Feldman W, McGrath P, Hodgson C, Ritter H, Shipman RT: The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent abdominal pain. Am J Dis Child 130:1216–1218, 1985Google Scholar
  15. 15.
    Boyle JT: Chronic abdominal pam.In Pediatric Gastrointestinal Disease. WA Walker et al (eds). BC Decker, 1991 pp 45–54Google Scholar
  16. 16.
    Hyams JS: Chronic abdominal pain caused by sorbitol malabsorption. J Pediatr 100:772, 1982Google Scholar
  17. 17.
    Editorial: Recurrent abdominal pain in childhood. Br Med J 1:1096, 1980Google Scholar
  18. 18.
    DiPalma JA, Narvaez RM: Prediction of lactose malabsorption in referral patients. Dig Dis Sci 33:303–307, 1988Google Scholar
  19. 19.
    Tolliver BA, Herrera JL, DiPalma JA: Evaluation of patients who meet clinical criteria for irritable bowel syndrome. Am J Gastroenterol 89:176–178, 1994Google Scholar
  20. 20.
    DiPalma JA, Jackson MS, Jackson KL, Tolliver BA, Barnett ED, Allen JF: Does lactose maldigestion play a role in irritable bowel syndrome? Gastroenterology 106:A488, 1994Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Rebecca B. Webster
    • 1
    • 2
  • Jack A. DiPalma
    • 1
    • 2
  • David A. Gremse
    • 1
    • 2
  1. 1.Division of Pediatric Gastroenterology and NutritionUniversity of South Alabama College of MedicineMobile
  2. 2.Division of GastroenterologyUniversity of South Alabama College of MedicineMobile

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