Current Treatment Options in Gastroenterology

, Volume 11, Issue 1, pp 19–25 | Cite as

Lactose malabsorption

  • Richard J. GrandEmail author
  • Robert K. Montgomery

Opinion statement

Lactose malabsorption is a syndrome producing constellation of symptoms, including abdominal pain, bloating, flatulence, diarrhea, and sometimes nausea and/or vomiting. Primary causes of lactose malabsorption due to loss of intestinal lactase activity include genetic/racial lactase nonpersistence, congenital lactase deficiency, and developmental lactase deficiency. Secondary lactose malabsorption can be caused by any disorder that injures the small intestinal mucosa, such as viral gastroenteritis, celiac disease, allergic (eosinophilic) gastroenteritis, and radiation enteritis. The diagnosis depends on careful clinical evaluation and is customarily confirmed with a lactose breath hydrogen test. As the symptoms are nonspecific, many adults diagnosed with lactose malabsorption actually have irritable bowel syndrome. Treatment consists of a trial of eliminating lactose-containing dairy foods, with supplementation of alternative calcium and protein sources. Commercial enzyme products containing β-galactosidases can be prescribed to help patients digest dietary lactose. Long-term lactose restriction usually is not necessary and can lead to reduced bone mineral density.


Lactose Irritable Bowel Syndrome Celiac Disease Lactase Breath Hydrogen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Chitkara DK, Montgomery RK, Grand RJ, Büller HA: Lactose intolerance. In Rose BD, ed. UpToDate [CD-ROM]. Waltham, MA: UpToDate; 2007.Google Scholar
  2. 2.
    Buller HA, Grand RJ: Lactose intolerance. Ann Rev Med 1990, 41:141–148.PubMedGoogle Scholar
  3. 3.
    Grand RJ, Montgomery RK, Chitkara DK, Hirschhorn JN: Changing genes; losing lactase. Gut 2003, 52:617–619.PubMedCrossRefGoogle Scholar
  4. 4.
    Escher JC, de Koning ND, van Engen CG, et al.: Molecular basis of lactase levels in adult humans. J Clin Invest 1992, 89:480–483.PubMedCrossRefGoogle Scholar
  5. 5.
    Fajardo O, Naim HY, Lacey SW: The polymorphic expression of lactase in adults is regulated at the messenger RNA level. Gastroenterology 1994, 106:1233–1241.PubMedGoogle Scholar
  6. 6.
    Troelsen JT: Adult-type hypolactasia and regulation of lactase expression. Biochim Biophys Acta 2005, 1723:19–32.PubMedGoogle Scholar
  7. 7.
    Sahi T: Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol Suppl 1994, 202:7–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Scrimshaw NS, Murray EB: The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr 1988, 48:1079–1159.PubMedGoogle Scholar
  9. 9.
    Enattah NS, Sahi T, Savilahti E, et al.: Identification of a variant associated with adult-type hypolactasia. Nat Genet 2002, 30:233–237.PubMedCrossRefGoogle Scholar
  10. 10.
    Mulcare CA, Weale ME, Jones AL, et al.: The T allele of a single-nucleotide polymorphism 13.9 kb upstream of the lactase gene (LCT) (C-13.9kbT) does not predict or cause the lactase-persistence phenotype in Africans. Am J Hum Genet 2004, 74:1102–1110.PubMedCrossRefGoogle Scholar
  11. 11.
    Tishkoff SA, Reed FA, Ranciaro A, et al.: Convergent adaptation of human lactase persistence in Africa and Europe. Nat Genet 2007, 39:31–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Newcomer A, McGill D, Thomas P, Hofman A: Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 1975, 293:1232–1236.PubMedCrossRefGoogle Scholar
  13. 13.
    Shaw AD, Davies GJ: Lactose intolerance: problems in diagnosis and treatment. J Clin Gastroenterol 1999, 28:208–216.PubMedCrossRefGoogle Scholar
  14. 14.
    Heyman MB: Lactose intolerance in infants, children, and adolescents. Pediatrics 2006, 118:1279–1286.PubMedCrossRefGoogle Scholar
  15. 15.
    Suarez FL, Savaiano DA, Levitt MD: A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995, 333:1–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Vesa T, Seppo L, Marteau P, et al.: Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr 1998, 67:710–715.PubMedGoogle Scholar
  17. 17.
    Bohmer C, Tuynman H: The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study. Eur J Gastroenterol Hepatol 2001, 13:941–944.PubMedCrossRefGoogle Scholar
  18. 18.
    Joseph F, Rosenberg AJ: Breath hydrogen testing: diseased versus normal patients. J Pediatr Gastroenterol Nutr 1988, 7:787–788.PubMedCrossRefGoogle Scholar
  19. 19.
    Hyams JS, Stafford RJ, Grand RJ, Watkins JB: Correlation of lactose breath hydrogen test, intestinal morphology, and lactase activity in young children. J Pediatr 1980, 97:609–612.PubMedCrossRefGoogle Scholar
  20. 20.
    Suarez FL, Savaiano D, Arbisi P, Levitt MD: Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr 1997, 65:1502–1506.PubMedGoogle Scholar
  21. 21.
    Johnson AO, Semenya JG, Buchowski MS, et al.: Correlation of lactose maldigestion, lactose intolerance, and milk intolerance. Am J Clin Nutr 1993, 57:399–401.PubMedGoogle Scholar
  22. 22.
    Suarez F, Adshead J, Furne J, Levitt M: Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. Am J Clin Nutr 1998, 68:1118–1122.PubMedGoogle Scholar
  23. 23.
    Pribila BA, Hertzler SR, Martin BR, et al.: Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy-rich diet. J Am Diet Assoc 2000, 100:524–528.PubMedCrossRefGoogle Scholar
  24. 24.
    Di Stefano M, Veneto G, Malservisi S, et al.: Lactose malabsorption and intolerance and peak bone mass. Gastroenterology 2002, 122:1793–1799.PubMedCrossRefGoogle Scholar
  25. 25.
    Honkanen R, Kroger H, Alhava E, et al.: Lactose intolerance associated with fractures of weight-bearing bones in Finnish women aged 38–57 years. Bone 1997, 21:473–477.PubMedCrossRefGoogle Scholar
  26. 26.
    Infante D, Tormo R: Risk of inadequate bone mineralization in diseases involving long-term suppression of dairy products. J Pediatr Gastroenterol Nutr 2000, 30:310–313.PubMedCrossRefGoogle Scholar
  27. 27.
    Harvey JA, Zobitz MM, Pak CY: Dose dependency of calcium absorption: a comparison of calcium carbonate and calcium citrate. J Bone Miner Res 1988, 3:253–258.PubMedCrossRefGoogle Scholar
  28. 28.
    Sheikh MS, Santa Ana CA, Nicar MJ, et al.: Gastrointestinal absorption of calcium from milk and calcium salts. N Engl J Med 1987, 317:532–536.PubMedCrossRefGoogle Scholar
  29. 29.
    Gordon CM, DePeter KC, Feldman HA, et al.: Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004, 158:531–537.PubMedCrossRefGoogle Scholar
  30. 30.
    Rosado JL, Solomons NW, Lisker R, Bourges H: Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime. Gastroenterology 1984, 87:1072–1082.PubMedGoogle Scholar
  31. 31.
    Ramirez FC, Lee K, Graham DY: All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial. Am J Gastroenterol 1994, 89:566–570.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.GI Cell and Molecular Biology Laboratory, Division of Gastroenterology and Nutrition, Department of Medicine, and General Clinical Research CenterChildren’s Hospital BostonBostonUSA

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