Abstract
Intolerance to foods which contain lactose can cause a range of intestinal and systemic symptoms. These symptoms are caused by Lactase deficiency which is encoded by a single gene (LCT) of ≈ 50 kb located on chromosome 2q21. In some food items, lactose has been missed because of “hidden” lactose due to inadequately labeled, confusing diagnosis of lactose intolerance based on dietary restriction of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. The key in the management of lactose intolerance is the dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of “risk” foods, inadequately labeled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the types, symptoms and management of lactose intolerance and also highlights differences from milk allergy which closely mimics the symptoms of lactose intolerance.
Similar content being viewed by others
References
Lentze MJ, Branski D. Carbohydrate malabsorption. In: Kliegman RM, Stanton BMD, St. Geme J, Schor N, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2012. pp. 1317–8.
Riaz A. Lactose intolerance. In: Riaz A, ed. Textbook of Pediatric Gastrology and Hepatology. 3rd ed. Hyderabad: Paras publication; 2008. pp. 88–92.
Mathews SB, Waud JP, Roberts AG, Campbell AK. Systemic lactose intolerance: A new prospective on an old problem. Postgrad Med J. 2005;81:167–73.
Vesa TH, Marteaue P, Korpela R. Lactose intolerance. Am J Clin Nutr. 2000;19:165–75.
Lomer MCE, Parkes GC, Sanderson JD. Lactose intolerance in clinical practice- Myths and realities. Aliment Pharmacol Ther. 2008;27:93–103.
Semenza G. Anchoring and biosynthesis of stalked brush border membrane proteins: Glycosidases and peptidases of enterocytes and renal tubuli. Annu Rev Cell Biol. 1986;2:255–313.
Savilahti E, Launiala K, Kuitunen P. Congenital lactase deficiency. A clinical study on 16 patients. Arch Dis Child. 1983;58:246–52.
Johnson JD. The regional and ethnic distribution of lactose malabsorption: adaptive and genetic hypotheses. In: Paige DM, Bayless TM, eds. Lactose Digestion: Clinical and Nutritional Implications. Baltimore: Johns Hopkins University Press; 1981. pp. 11–22.
Welsh JD, Griffiths WJ. Breath hydrogen test after oral lactose in postgastrectomy patients. Am J Clin Nutr. 1980;33:2324–7.
Bode S, Gudmand-Høyer E. Incidence and clinical significance of lactose malabsorption in adult coeliac disease. Scand J Gastroenterol. 1988;23:484–8.
Pironi L, Callegari C, Cornia GL, Lami F, Miglioli M, Barbara L. Lactose malabsorption in adult patients with Crohn’s disease. Am J Gastroenterol. 1988;83:1267–71.
Arrigoni E, Marteau P, Briet F, Pochart P, Rambaud JC, Messing B. Tolerance and absorption of lactose from milk and yogurt during short-bowel syndrome in humans. Am J Clin Nutr. 1994;60:926–9.
Parnes HL, Fung E, Schiffer CA. Chemotherapy-induced lactose intolerance in adults. Cancer. 1994;74:1629–33.
Sahi T, Launiala K. More evidence for the recessive inheritance of selective adult type lactose malabsorption. Gastroenterology. 1977;73:231–2.
Flatz G. The genetic polymorphism of intestinal lactase activity in adult humans. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases of Inherited Disease. III. 7th ed. New York: McGraw-Hill; 1995. pp. 4441–50.
Scrimshaw NS, Murray EB. Prevalence of lactose maldigestion. Am J Clin Nutr. 1988;48:1086–98.
Sahi T. Genetics and epidemiology of adult-type hypolactasia. Scand J Gastroenterol. 1994;29:S7–20.
Desai HG, Gupta UV, Pradhan AG, Thakkar KD. Incidence of lactase deficiency in India. Role of hereditary factors. Ind J Med Sci. 1970;24:729–36.
Reddy V, Pershad J. Lactase deficiency in Indians. Am J Clin Nutr. 1972;25:114–9.
Tandon RK, Goel U, Mukherjee SN, Pandey SC, Lal K. Lactose intolerance during pregnancy in different communites. Indian J Med Res. 1977;66:33–8.
Tandon RK, Joshi YK, Singh DS, Narendranathan M, Balakrishnan V, Lal K. Lactose intolerance in North and South Indians. Am J Clin Nutr. 1981;34:943–6.
Rao DR, Bello H, Warren AP, Brown GE. Prevalence of lactose maldigestion: Influence and interaction of age, race, and sex. Dig Dis Sci. 1994;39:1519–24.
Sahi T. The inheritance of selective adult-type lactose malabsorption. Scand J Gastroenterol Suppl. 1974;30:1–73.
Launiala K. The effect of unabsorbed sucrose and mannitol on the small intestinal flow rate and mean transit time. Scand J Gastroenterol. 1968;3:665–71.
Christopher NL, Bayless TM. Role of the small bowel and colon in lactose-induced diarrhea. Gastroenterology. 1971;60:845–52.
Ladas S, Papanikos J, Arapakis G. Lactose malabsorption in Greek adults: correlation of small bowel transit time with the severity of lactose intolerance. Gut. 1982;23:968–73.
Jouet P, Sabaté JM, Flourié B, Bouhnik Y, Coffin B, Francihisseur C, et al. Lactose intolerance: role of the colon and of changes in motor activity in the occurrence of symptoms. Gastroenterology. 1996;110:335.
Perman JA, Modler S, Olson AC. Role of pH in production of hydrogen from carbohydrates by colonic bacterial flora studies in vivo and in vitro. J Clin Invest. 1981;67:643–50.
Florent C, Flourié B, Leblond A, Rautureau M, Bernier JJ, Rambaud JC. Influence of chronic lactulose ingestion on the colonic metabolism of lactulose in man (an in vivo study). J Clin Invest. 1985;75:608–13.
Flourié B, Briet F, Florent C, Pellier P, Maurel M, Rambaud JC. Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose? Am J Clin Nutr. 1993;58:369–75.
Bond JH, Levitt MD. Quantitative measurement of lactose absorption. Gastroenterology. 1976;70:1058–62.
Koetse HA, Stellaard F, Bijleveld CMA, Elzinga H, Boverhof R, van der Meer R, et al. Non-invasive detection of low-intestinal lactase activity in children by use of a combined 13CO2/H2 breath test. Scand J Gastroenterol. 1999;34:35–40.
Contribution
Dr. Balvir S. Tomar will act as guarantor for this paper.
Conflict of Interest
None.
Role of Funding Source
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tomar, B.S. Lactose Intolerance and Other Disaccharidase Deficiency. Indian J Pediatr 81, 876–880 (2014). https://doi.org/10.1007/s12098-014-1346-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-014-1346-2