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Area of Science:

  • Gastroenterology
  • Digestive Health
  • Gut-Brain Interactions

Background:

  • Lactose malabsorption is often presumed to cause gastrointestinal issues, yet symptoms frequently persist even with dietary changes or enzyme use.
  • This highlights a potential disconnect between lactose malabsorption and reported symptoms in patients.

Purpose of the Study:

  • To investigate the relationship between lactose ingestion symptoms and actual lactose malabsorption.
  • To explore the association of these symptoms with fructose sensitivity and disorders of the gut-brain interactions (DGBIs).

Main Methods:

  • 753 patients with DGBIs underwent hydrogen breath tests to identify lactose malabsorption (LM+).
  • The adult Carbohydrate Perception Questionnaire (aCPQ) and visual analogue scale (VAS) assessed lactose-induced symptoms (LS+).
  • Fructose sensitivity was evaluated in 547 patients using a similar protocol.

Main Results:

  • Lactose malabsorption (LM+) occurred in 40.9% of patients, while 55.4% reported lactose-induced symptoms (LS+).
  • A significant portion of symptomatic patients (45.3%) did not have lactose malabsorption, and 26.0% of malabsorbers were asymptomatic.
  • Symptomatic patients (LS+) were more likely to have fructose sensitivity (45.2% vs. 24.2%, p < 0.001).
  • Functional dyspepsia and irritable bowel syndrome were more prevalent in LS+ patients, regardless of malabsorption status.

Conclusions:

  • Lactose malabsorption alone is insufficient to predict symptom occurrence, necessitating broader symptom evaluation beyond breath tests.
  • Findings suggest overlapping mechanisms and visceral hypersensitivity in symptom development, particularly with co-existing fructose sensitivity.
  • This underscores the importance of personalized therapeutic strategies for patients with DGBIs.