Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin 3.
St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria.
Eur J Gastroenterol Hepatol. 2022 Mar 1;34(3):274-280. doi: 10.1097/MEG.0000000000002283.
Lactose malabsorption and lactose-induced symptoms are poorly correlated, as shown by breath tests and various symptom assessment methods. Validated assessment is the key to overcome the limitations of biased symptom measurements. We characterized lactose-induced symptoms with the population-specific, validated paediatric carbohydrate perception questionnaire (pCPQ) and their correlation with the history of symptoms (HoS).
A total of 130 patients with functional gastrointestinal symptoms underwent a lactose hydrogen breath and tolerance test (LBTT) allowing for a diagnosis of malabsorption (M+) and lactose sensitivity (S+). HoS indicative of lactose-induced symptoms (abdominal pain, nausea, bloating, flatulence, diarrhoea) in the 4 weeks preceding the test was determined using a validated questionnaire. The pCPQ was used to score lactose-induced symptoms.
The LBTT revealed 41 children (31.5%) with lactose malabsorption (M+), 56 (43.1%) with lactose sensitivity (S+) and 24 (18.5%) were M+/S+. Sensitivity correlated with HoS (P < 0.001), regardless of whether malabsorption was detectable. Malabsorption status did not correlate with HoS (NS). The odds of lactose sensitivity significantly increased when abdominal pain [odds ratio (OR) 3.5, confidence interval (CI) 1.6-7.8], nausea (OR 2.3, CI, 1.1-4.9) and flatulence (OR 3.1, CI 1.4-6.8) were reported in the 4 weeks preceding the LBTT. Symptoms after the lactose load were similar for M+/S+ and M-/S+, except for flatulence, which was more frequent in malabsorbers (P < 0.01).
Our findings fit well with the emerging view of the important role of a validated symptom assessment after a lactose load. The determination of symptoms may be more relevant than malabsorption for the clinical outcomes of paediatric patients with lactose-related gastrointestinal symptoms.
乳糖吸收不良和乳糖引起的症状相关性较差，这一点可通过呼气试验和各种症状评估方法得到证实。经过验证的评估是克服有偏差的症状测量限制的关键。我们使用具有人群特异性的、经过验证的小儿碳水化合物感知问卷（pCPQ）来描述乳糖引起的症状，并将其与症状史（HoS）相关联。
共有 130 名功能性胃肠道症状患者接受了乳糖氢呼气和耐量试验（LBTT），该试验可诊断为吸收不良（M+）和乳糖敏感（S+）。使用经过验证的问卷确定试验前 4 周内与乳糖相关的症状（腹痛、恶心、腹胀、气胀、腹泻）的 HoS。使用 pCPQ 对乳糖引起的症状进行评分。
LBTT 显示 41 名儿童（31.5%）存在乳糖吸收不良（M+），56 名（43.1%）存在乳糖敏感（S+），24 名（18.5%）为 M+/S+。敏感性与 HoS 相关（P < 0.001），而与是否可检测到吸收不良无关。吸收不良状态与 HoS 不相关（NS）。当报告试验前 4 周内存在腹痛（比值比 [OR] 3.5，95%置信区间 [CI] 1.6-7.8）、恶心（OR 2.3，CI 1.1-4.9）和气胀（OR 3.1，CI 1.4-6.8）时，乳糖敏感的可能性显著增加。M+/S+和 M-/S+患者在乳糖负荷后出现的症状相似，除了气胀在吸收不良者中更为常见（P < 0.01）。
我们的发现与在乳糖负荷后进行经过验证的症状评估的重要作用的新观点相符。对于患有乳糖相关胃肠道症状的儿科患者，症状的确定可能比吸收不良更能反映临床结局。
