Advertisement

Quick Test: A New Test for the Diagnosis of Duodenal Hypolactasia

  • Veronica Ojetti
  • Rossella La Mura
  • Maria Assunta Zocco
  • Paola Cesaro
  • Ercole De Masi
  • Antonietta La Mazza
  • Giovanni Cammarota
  • Giovanni Gasbarrini
  • Antonio GasbarriniEmail author
Original Paper

Abstract

The hydrogen (H2) lactose breath test (BT) is a test commonly used for the diagnosis of hypolactasia. However, its sensitivity is not always good. In the last few years, the new Quick Lactase Test (QLT) has been developed for endoscopic diagnosis of adult-type hypolactasia. The aim of this study was to compare the efficacy of the new QLT with the traditional H2 lactose BT for the diagnosis of hypolactasia. Fifty dyspeptic patients (19 male, 31 female, mean age 38 ± 6) were enrolled in the study. All the patients were subjected to the H2 lactose BT and to upper gastrointestinal endoscopy. Two postbulbar duodenal biopsies were used for the QLT (Biohit, Helsinki, Finland). The duodenum biopsies were incubated with lactose on a test plate: in patients with normolactasia a colour reaction develops as a result of hydrolysed lactose (positive result), whereas no reaction develops in patients with mild or severe hypolactasia (negative results). Twenty-two out of 50 patients (44%) had a positive H2 lactose BT. Among them, 21 showed a mild or severe hypolactasia with the QLT. When we considered patients with a negative H2 lactose BT (28 out of 50), 24 patients showed normal lactase activity in duodenal biopsies with the QLT, whereas in 4 patients there was discordance between the two tests. These patients were re-evaluated with a methane (CH4) and an H2 lactose BT and 3 of them were H2 non-producers with a high level of CH4 production. Only 1 patient with a negative result in the QLT remains negative to lactose BT. Our study showed a good correlation between the H2 lactose BT and the new QLT in the diagnosis of adult-type hypolactasia for the majority of patients. However, the QLT seems to be more sensitive than the H2 lactose BT, helping to identify a subgroup of patients with adult-type hypolactasia with a negative result in the H2 lactose BT. Based on these results we suggest performing the less expensive and more rapid QLT during the upper gastrointestinal endoscopy to evaluate the presence of lactase activity in duodenal biopsies.

Keywords

Breath test Hypolactasia Quick lactase test Duodenal biopsies 

References

  1. 1.
    Naim HY (2001) Molecular and cellular aspects and regulation of intestinal lactase-phlorizin hydrolase. Histol Histopathol 16(2):553–561PubMedGoogle Scholar
  2. 2.
    Lloyd ML, Olsen WA (1999) Disaccharide malabsorption. Gastroenterology T6:1087–1100Google Scholar
  3. 3.
    Gremse DA, Greer AS, Vacik J et al (2003) Abdominal pain associated with lactose ingestion in children with lactose intolerance. Clin Pediatr (Phila) 42(4):341–345CrossRefGoogle Scholar
  4. 4.
    Swagerty DL Jr, Walling AD, Klein RM (2002) Lactose intolerance. Am Fam Physician 65(9):1845–1850PubMedGoogle Scholar
  5. 5.
    Bayless TM, Paige DM, Bedine MS (1995) Lactose intolerance. N Engl J Med 333(20):1358–1359PubMedCrossRefGoogle Scholar
  6. 6.
    Semenza G, Auricchio S, Mantei N (2001) Small-intestinal disaccharidases. In: Scriver CR, Beaudet AL, Sly D, Valle D (eds) The metabolic and molecular basis of inherited disease, vol 1. McGraw-Hill, New York, pp 623–650Google Scholar
  7. 7.
    Montalto M, Curigliano V, Santoro L et al (2006) Management and treatment of lactose malabsorption. World J Gastroenterol 12(2):187–191PubMedGoogle Scholar
  8. 8.
    Corazza GR, Ginaldi L, Furia N et al (1997) The impact of HIV infection on lactose absorptive capacity. J Infect 35(1):31–35PubMedCrossRefGoogle Scholar
  9. 9.
    Ojetti V, Nucera G, Migneco A et al (2005) High prevalence of celiac disease in patients with lactose intolerance. Digestion 71(2):106–110PubMedCrossRefGoogle Scholar
  10. 10.
    Strocchi A, Corazza G, Furne J et al (1996) Measurements of the jejunal unstirred layer in normal subjects and patients with celiac disease. Am J Physiol 270(3 Pt 1):G487–G491PubMedGoogle Scholar
  11. 11.
    Von Tirpitz C, Kohn C, Steinkamp M et al (2002) Lactose intolerance in active Crohn’s disease: clinical value of duodenal lactase analysis. J Clin Gastroenterol 34(1):49–53CrossRefGoogle Scholar
  12. 12.
    Messer M, Dahlqvist A (1966) A one-step ultramicro method for the assay of intestinal disaccharidases. Anal Biochem 14:376–392PubMedCrossRefGoogle Scholar
  13. 13.
    Shaw AD, Davies GJ (1999) Lactose intolerance: problems in diagnosis and treatment. J Clin Gastroenterol 28:208–216PubMedCrossRefGoogle Scholar
  14. 14.
    Rasinpera H, Savilahti E, Enattah NS et al (2004) A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut 53:1571–1576PubMedCrossRefGoogle Scholar
  15. 15.
    Enattah NS, Sahi T, Savilahti E et al (2002) Identification of a variant associated with adult-type hypolactasia. Nat Genet 30:233–237PubMedCrossRefGoogle Scholar
  16. 16.
    Kuokkanen M , Enattah N, Oksanen A et al (2003) Transcriptional regulation of the lactase-phlorizin hydrolase gene by polymorphisms associated with adult-type hypolactasia. Gut 52:647–652PubMedCrossRefGoogle Scholar
  17. 17.
    Bodanszky H, Horvath K, Bata A et al (1987) Hydrogen breath test in small intestinal malabsorption. Acta Paediatr Hung 28(1):45–49PubMedGoogle Scholar
  18. 18.
    Romagnuolo J, Schiller D, Bailey RJ (2002) Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. Am J Gastroenterol 97(5):1113–1126PubMedCrossRefGoogle Scholar
  19. 19.
    Arola H (1994) Diagnosis of hypolactasia and lactose malabsorption. Scand J Gastroenterol Suppl 202:26–35PubMedCrossRefGoogle Scholar
  20. 20.
    Kuokkanen M, Myllyniemi M, Vauhkonen M et al (2006) A biopsy-based quick test in the diagnosis of duodenal hypolactasia in upper gastrointestinal endoscopy. Endoscopy 38(7):708–712PubMedCrossRefGoogle Scholar
  21. 21.
    Marsh MN, Crowe PT (1995) Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol 9:273–293PubMedCrossRefGoogle Scholar
  22. 22.
    Nucera G, Gabrielli G, Lupascu A et al (2005) Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Alim Pharmacol Therapeut 21:1391–1395CrossRefGoogle Scholar
  23. 23.
    Corazza GR, Sorge M, Strocchi A et al (1990) Methodology of the H2 breath test. II. Importance of the test duration in the diagnosis of carbohydrate malabsorption. Ital J Gastroenterol 22(5):303–305PubMedGoogle Scholar
  24. 24.
    Cloarec D, Bornet F, Gouilloud S et al (1990) Breath hydrogen response to lactulose in healthy subjects: relationship to methane producing status. Gut 31(3):300–304PubMedCrossRefGoogle Scholar
  25. 25.
    Corazza G, Strocchi A, Sorge M, Bentai G, Gasbarrini G (1993) Prevalence and consistency of low breath H2 excretion following lactulose ingestion. Possible implications for the clinical use of the H2 breath test. Dig Dis Sci 38(11):2010–2016PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Veronica Ojetti
    • 1
  • Rossella La Mura
    • 1
  • Maria Assunta Zocco
    • 1
  • Paola Cesaro
    • 1
  • Ercole De Masi
    • 2
  • Antonietta La Mazza
    • 3
  • Giovanni Cammarota
    • 1
  • Giovanni Gasbarrini
    • 1
  • Antonio Gasbarrini
    • 1
    Email author
  1. 1.Department of Internal Medicine, Gemelli HospitalCatholic UniversityRomeItaly
  2. 2.Gastroenterology UnitS Carlo di Nancy HospitalRomeItaly
  3. 3.Gastroenterology UnitLa Sapienza UniversityRomeItaly

Personalised recommendations