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Improved accuracy of lactose tolerance test in children, using expired H2 measurement
Insights
Hydrogen breath tests accurately diagnose lactose intolerance in children. Blood glucose rise is unreliable for distinguishing lactose tolerance from intolerance, with significant diagnostic errors.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Clinical Diagnostics
Background:
- Lactose intolerance is a common condition affecting children.
- Accurate diagnosis is crucial for managing gastrointestinal symptoms.
- Existing diagnostic methods require evaluation for improved accuracy.
Purpose of the Study:
- To assess the diagnostic accuracy of hydrogen breath tests (HBT) and blood glucose measurements in children.
- To differentiate between lactose malabsorption and clinical lactose intolerance.
- To evaluate the reliability of blood glucose response in diagnosing lactose digestion.
Main Methods:
- Oral lactose tolerance test administered to 163 children (9 months–14 years).
- Measured expired hydrogen (H2) and blood glucose levels post-lactose ingestion.
- Defined lactose malabsorption by increased expired H2; lactose intolerance by increased H2 plus symptoms.
Main Results:
- Lactose malabsorption detected in 54 children; 30 diagnosed with lactose intolerance.
- 109 children showed normal lactose absorption based on H2 levels.
- Blood glucose rise was significantly different between tolerant and intolerant groups (p < 0.001), but misdiagnosed 13% of tolerant and 37% of intolerant cases.
Conclusions:
- Hydrogen breath testing is a reliable method for diagnosing lactose malabsorption and intolerance in children.
- Blood glucose response following lactose challenge is not a reliable indicator for differentiating lactose tolerance from intolerance.
- Elevated blood glucose thresholds offer limited value in clinical diagnosis of pediatric lactose digestion issues.
Abstract:
Expired hydrogen and blood glucose were measured during an oral lactose tolerance test in 163 children aged between 9 months and 14 years. Lactose malabsorption, defined as an abnormal increase in expired H2 during a lactose tolerance test, was found in 54 children. Of these, 30 were found to be lactose intolerant as the increased expired H2 was accompanied by clinical symptoms. The other 109 children, in whom there was no rise in expired H2, were assumed to have normal lactose absorption. In children with lactose intolerance the increase in expired H2 tended to occur earlier after lactose ingestion than in children with malabsorption. The mean value of the rise in blood glucose was 2.4 mmol/100 ml) in the lactose-tolerant children and 1.0 mmol/1 (18 mg/100 ml) in the lactose-intolerant ones. Although this difference is significant (p less than 0.001), the rise in blood glucose, in predicting the correct diagnosis, was wrong in 13% of cases in the lactose-tolerant group, and wrong in 37% in the lactose-intolerant group (95% confidence limits 9-19% and 22-53% respectively). It is concluded that a rise in blood glucose, whether or not of more that 1.2 mmol/1 (22mg/100 ml) is of little help in differentiating lactose tolerance from intolerance.