Bodé S, Gudmand-Høyer E
Dept. of Internal Medicine and Gastroenterology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Scand J Gastroenterol. 1988 May;23(4):484-8. doi: 10.3109/00365528809093898.
Fifty-one adult patients with coeliac disease, verified by a proximal small-intestinal biopsy, were investigated. Before treatment with a gluten-free and low-lactose diet 52% showed a slight rise in blood glucose during the lactose tolerance test. Seventy-nine per cent of these patients had watery stools, and 88% had three or more bowel movements a day--statistically significantly different from the coeliac patients with a normal lactose tolerance test. After treatment 12% had a flat lactose tolerance curve. Half of them (6%) had specific lactase deficiency. This is approximately the incidence of lactose malabsorption in the general Danish population. The small-intestinal disaccharidases and alkaline phosphatase levels were severely depressed before treatment. After treatment the activities increased, but not to normal. We conclude that lactose malabsorption is a clinically important condition in many patients with untreated coeliac disease, giving rise to more frequent and more watery stools. In well-treated coeliac disease lactose malabsorption is not commoner than in the general population. The lactose activity in a proximal intestinal biopsy specimen was found to be an unreliable indicator of lactose malabsorption in coeliac disease.
对51例经近端小肠活检确诊为乳糜泻的成年患者进行了研究。在采用无麸质和低乳糖饮食治疗前，52%的患者在乳糖耐量试验期间血糖略有升高。这些患者中79%有水样便，88%每天排便3次或更多次，与乳糖耐量试验正常的乳糜泻患者相比有统计学显著差异。治疗后，12%的患者乳糖耐量曲线呈平坦状。其中一半患者（6%）有特异性乳糖酶缺乏。这与丹麦普通人群中乳糖吸收不良的发生率相近。治疗前小肠双糖酶和碱性磷酸酶水平严重降低。治疗后活性增加，但未恢复正常。我们得出结论，乳糖吸收不良在许多未经治疗的乳糜泻患者中是一种具有临床重要性的情况，会导致更频繁和更稀的水样便。在治疗良好的乳糜泻患者中，乳糖吸收不良并不比普通人群更常见。发现近端小肠活检标本中的乳糖活性是乳糜泻中乳糖吸收不良的不可靠指标。
