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Lactose maldigestion and recurrent abdominal pain in children
R B Webster1, J A DiPalma, D A Gremse
1Division of Pediatric Gastroenterology and Nutrition, University of South Alabama, Mobile 36640-0130, USA.
Insights
Many children with recurrent abdominal pain experience lactose maldigestion, a condition not easily predicted by symptoms alone. A lactose-restricted diet improved symptoms, suggesting breath hydrogen testing for lactose maldigestion is valuable.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutritional Science
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint.
- Lactose maldigestion is a potential contributor to gastrointestinal symptoms in children.
- Predicting lactose maldigestion based on clinical presentation alone is challenging.
Purpose of the Study:
- To evaluate the prevalence of lactose maldigestion in children with RAP.
- To identify clinical factors that may predict lactose absorption status.
- To assess the impact of a lactose-restricted diet on symptom improvement.
Main Methods:
- A cohort of 137 children with RAP underwent clinical evaluation, dietary interviews, and laboratory tests.
- Lactose hydrogen breath testing was performed to diagnose lactose maldigestion.
- Symptom prevalence and improvement with dietary changes were recorded.
Main Results:
- Lactose maldigestion was detected in 24% (33/137) of children with RAP.
- No clinical parameters reliably predicted lactose maldigestion.
- Children with lactose maldigestion showed clinical improvement on a lactose-restricted diet.
Conclusions:
- Clinical evaluation alone is insufficient to diagnose lactose maldigestion in children with RAP.
- Formal lactose hydrogen breath testing should be considered for children with persistent abdominal pain.
- Dietary modification can be beneficial for children diagnosed with lactose maldigestion.
Abstract:
Our objectives were to evaluate children with recurrent abdominal pain for lactose maldigestion and to assess factors which might predict lactose absorption status. One hundred thirty-seven children were referred for specialty evaluation of recurrent abdominal pain of at least three months' duration. Study subjects were evaluated by history and physical examination, dietary interviews, hematologic and biochemical laboratory testing, stool parasite examination, and radiologic or endoscopic structural examinations, as indicated. Lactose hydrogen breath testing was performed after challenge with 1 g/kg lactose 10% aqueous solution). There were 53 males and 84 females, whose ages ranged from 6 to 18 years (9.64 +/- 2.9; mean +/- SD) Lactose maldigestion was detected in 33/137 patients (24%). The prevalence of abdominal pain, bloating, gas, flatulence, diarrhea, and constipation was similar in children with or without lactose maldigestion. The perception of symptoms related to the ingestion of dairy products was similar in both groups. No other clinical parameter predicted lactose maldigestion. However, children with lactose maldigestion had overall clinical improvement with a lactose-restricted diet. Clinical evaluation alone cannot adequately predict the presence of lactose maldigestion in children. Formal evaluation for lactose maldigestion using breath hydrogen testing methods should be considered in children with recurrent abdominal pain.