Mishkin S
Department of Medicine, McGill University, Montréal, Québec, Canada.
Am J Clin Nutr. 1997 Feb;65(2):564-7. doi: 10.1093/ajcn/65.2.564.
The ability of inflammatory bowel disease (IBD) patients to tolerate dairy products and the guidance they receive from physicians and nutritionists on this subject are important considerations in the management of their IBD. Although most affected persons are able to consume a glass of milk daily without discomfort, additional consideration must be given to specific factors that can be relevant to certain individuals. The declaration by patients that they are "dairy sensitive" may be related to lactose intolerance or malabsorption, the long-chain triacylglycerol content of milk, allergy to milk proteins, as well as psychologic factors and the misconception that dairy products can be detrimental to their health. The prevalence of lactose malabsorption is significantly greater in patients with Crohn disease involving the small bowel than it is in patients with Crohn disease involving the colon or ulcerative colitis. In the latter colonic conditions the prevalence of lactose malabsorption is mainly determined by ethnic risk, which is based on genetic factors. In addition, lactose malabsorption in Crohn disease of the small bowel may be determined by factors other than lactase enzyme activity, such as bacterial overgrowth and/or small bowel transit time. Physicians differ widely in the advice they give their patients: some dogmatically advise avoidance of dairy products when the diagnosis is made whereas others discount the possible role of dairy in the management of IBD. IBD patients avoid dairy products more than they would need to based on the prevalence of lactose malabsorption and/or milk intolerance, probably partly because of incorrect patient perceptions and arbitrary advice from physicians and authors of popular diet books. Adequate scientific and clinical information is now available to permit recommendations about the intake of dairy products for each IBD patient.
炎症性肠病（IBD）患者耐受乳制品的能力以及他们从医生和营养师那里获得的关于这一问题的指导意见，是IBD管理中的重要考量因素。尽管大多数患者能够每天饮用一杯牛奶而无不适，但对于某些个体可能相关的特定因素仍需额外考虑。患者宣称自己“对乳制品敏感”可能与乳糖不耐受或吸收不良、牛奶中的长链三酰甘油含量、对牛奶蛋白过敏以及心理因素和认为乳制品对健康有害的误解有关。涉及小肠的克罗恩病患者中乳糖吸收不良的患病率显著高于涉及结肠的克罗恩病患者或溃疡性结肠炎患者。在后一种结肠疾病中，乳糖吸收不良的患病率主要由基于遗传因素的种族风险决定。此外，小肠克罗恩病中的乳糖吸收不良可能由乳糖酶活性以外的因素决定，如细菌过度生长和/或小肠转运时间。医生给患者的建议差异很大：一些医生在做出诊断时教条地建议患者避免食用乳制品，而另一些医生则忽视了乳制品在IBD管理中可能起到的作用。IBD患者基于乳糖吸收不良和/或牛奶不耐受的患病率而过度避免食用乳制品，这可能部分是由于患者的错误认知以及医生和流行饮食书籍作者的随意建议。现在已有足够的科学和临床信息，可为每位IBD患者的乳制品摄入量提供建议。
