Hasegawa Matsuri, Okada Kazuko, Nagata Satoru, Sugihara Shigetaka
Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Arakawa-ku 116-8561, Tokyo, Japan.
Department of Pediatrics, Okada Pediatric Clinic, Shinjuku-ku 169-0072, Tokyo, Japan.
World J Clin Cases. 2023 Feb 6;11(4):797-808. doi: 10.12998/wjcc.v11.i4.797.
Lactose intolerance (LI) is commonly seen in East Asian countries. Several studies showed that lactose or milk loading has been used as a treatment for lactose malabsorption (LM) in Western countries, but there have been no reports regarding this type of treatment in Japan. As lactose or milk loading requires ingestion of large amounts of lactose within a short period, this is considered to be too harsh for Japanese people because of their less habitual milk consumption (175 mL per day in average) than Western people. In this study, we demonstrated lactose tolerance acquisition in a suitable way for Japanese.
To examine the efficacy of lactose (cow's milk) loading treatment in patients with LM.
Individuals with abdominal symptoms induced by milk or dairy products (LI symptoms) were identified with a questionnaire. A 20 g lactose hydrogen breath test (LHBT) was carried out to confirm LM diagnosis and to evaluate co-existence of small intestinal bacterial overgrowth (SIBO). Respondents diagnosed with LM were selected as study subjects and were treated with incremental loads of cow's milk, starting from 30 mL and increasing up to 200 mL at 4-7 d intervals. After the treatment, changes in symptoms and LM diagnostic value of 20 g LHBT were investigated. Stool samples pre- and post-treatment were examined for changes in intestinal microbiota using 16S rRNA sequencing. Informed consent was obtained prior to each stage of the study.
In 46 subjects with LI symptoms (10-68 years old, mean age 34 years old) identified with the questionnaire, 35 (76.1%) were diagnosed with LM by 20 g LHBT, and 6 had co-existing SIBO. The treatment with incremental cow's milk was carried out in 32 subjects diagnosed with LM (14-68 years old, median age 38.5 years old). The mean period of the treatment was 41 ± 8.6 d. Improvement of symptoms was observed in 29 (90.6%; 95% confidence interval: 75.0%-98.0 %) subjects. Although 20 g LHBT indicated that 10 (34.5%) subjects had improved diagnostic value of LM, no change was observed in 16 (55.2%) subjects. Analysis of the fecal intestinal microbiota showed a significant increase in in 7 subjects who became symptom-free after the treatment ( = 0.0313).
LM was diagnosed in approximately 75% of the subjects who had LI. Incremental loads of cow's milk is regarded as a useful treatment for LM without affecting everyday life.
乳糖不耐受（LI）在东亚国家较为常见。多项研究表明，在西方国家，乳糖或牛奶负荷已被用作乳糖吸收不良（LM）的一种治疗方法，但在日本尚无关于此类治疗的报道。由于乳糖或牛奶负荷需要在短时间内摄入大量乳糖，鉴于日本人的牛奶消费量（平均每天175毫升）低于西方人，这种方法对日本人来说可能过于严苛。在本研究中，我们以适合日本人的方式证明了乳糖耐受性的获得。
研究乳糖（牛奶）负荷治疗对LM患者的疗效。
通过问卷调查确定有因牛奶或乳制品引起的腹部症状（LI症状）的个体。进行20克乳糖呼气氢试验（LHBT）以确认LM诊断并评估小肠细菌过度生长（SIBO）的共存情况。被诊断为LM的受访者被选为研究对象，并接受递增负荷的牛奶治疗，从30毫升开始，每隔4 - 7天增加至200毫升。治疗后，调查症状变化以及20克LHBT的LM诊断价值。使用16S rRNA测序检查治疗前后粪便样本中肠道微生物群的变化。在研究的每个阶段之前均获得了知情同意。
通过问卷调查确定的46名有LI症状的受试者（年龄10 - 68岁，平均年龄34岁）中，35名（76.1%）通过20克LHBT被诊断为LM，6名同时存在SIBO。32名被诊断为LM的受试者（年龄14 - 68岁，中位年龄38.5岁）接受了递增牛奶治疗。治疗的平均时间为41±8.6天。29名（90.6%；95%置信区间：75.0% - 98.0%）受试者的症状有所改善。虽然20克LHBT显示10名（34.5%）受试者的LM诊断价值有所改善，但16名（55.2%）受试者未观察到变化。对粪便肠道微生物群的分析显示，7名治疗后无症状的受试者中 显著增加（ = 0.0313）。
约75%有LI的受试者被诊断为LM。递增负荷的牛奶被认为是一种对LM有用的治疗方法，且不影响日常生活。
