Differentiating Lactose intolerance from other diseases: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{Lactose intolerance}} {{CMG}} ==Overview== The differential diagnosis must distinguish lactose intolerance from milk allergy, which is an abnormal immune re...")
 
Line 13: Line 13:
** Overuse of [[laxatives]]
** Overuse of [[laxatives]]
** Problems digesting foods that contain [[fructose]] and [[sorbitol]]
** Problems digesting foods that contain [[fructose]] and [[sorbitol]]
'''The table below summarizes the findings that differentiate watery causes of chronic diarrhea'''<ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }} </ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }} </ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }} </ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }} </ref>
<small>
{| class="wikitable"
! colspan="3" rowspan="2" |Cause
! colspan="2" |Osmotic gap
! rowspan="2" |History
! rowspan="2" |Physical exam
! rowspan="2" |Gold standard
! rowspan="2" |Treatment
|-
!< 50 mOsm per kg
!> 50 mOsm per kg*
|-
| rowspan="5" |Watery
| rowspan="3" |Secretory
|[[Crohns disease|Crohns]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Abdominal pain]] followed by [[diarrhea]]
|
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]]
* Blood seen on [[rectal exam]]
*[[Fever]]
*[[Tachycardia]]
*[[Hypotension]]
|
* [[Colonoscopy]] with [[biopsy]]
|
* Topical mucosamine and [[corticosteroids]] are preferred
* [[Mesalamine]] and [[sulfasalazine]] are used for remission
|-
|[[Hyperthyroidism]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Excessive [[sweating]]
* Heat intolerance
* [[Hypermotility|Increased bowel movements]]
|
* Lump in the neck
* [[Proptosis]]
* [[Tremors]]
* Increased DTR
|
* [[TSH]] with [[T3]] and [[T4]]
|
* [[Carbimazole]]  and [[methimazole]]
* [[Beta blockers]] like [[propylthiouracil]]
* [[Iodine-131]]
|-
|[[VIPoma]]
|<nowiki>+</nowiki>
| -
|
* Watery [[diarrhea]]
* [[Dehydration]]  ([[thirst]], [[dry skin]], [[dry mouth]], [[tiredness]], [[headaches]], and [[dizziness]])
* [[Lethargy]], [[muscle weakness]]
* [[Nausea]], [[vomiting]]
* Crampy [[abdominal pain]]
* [[Weight loss]]
* [[Flushing]]
|
* [[Tachycardia]]
* [[Rash]]
* [[Facial flushing]]
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right upper abdominal quadrant
|
* Elevated [[VIP]] levels
* Followed by imaging
|
* [[Sandostatin]] or [[chemotherapy]]  for [[malignant tumors]]
* Surgical removal of the [[tumor]]
|-
| rowspan="2" |[[Osmotic]]
|[[Lactose intolerance]]
| -
|<nowiki>+</nowiki>
|
:* [[Abdominal pain]]
:* [[Bloating]]
:* [[Diarrhea]]
:* [[Flatulence]]
|
* [[Abdominal tenderness]]
|
* Intestinal [[biopsy]]
|
* Avoidance of dietary [[lactose]]
* Substitution to maintain nutrient intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]
|-
|[[Celiac disease (patient information)|Celiac disease]]
| -
| +
|
* May be asymptomatic
* Vague [[abdominal pain]]
* [[Diarrhea]]
* [[Weight loss]]
* [[Malabsorption]] / [[steatorrhea]]
* Bloatedness
|
* [[Abdominal pain]] and [[cramping]]
* [[Abdominal distention]]
* [[Tetany]]
* [[Mouth ulcers]]
* [[Dermatitis herpetiformis]]
* Signs of the fat-soluble [[Vitamin A|vitamins A]], D, E, and K deficiency
|
* [[IgA]] tissue [[transglutaminase]] Ab
|
* [[Gluten-free diet]]
|-
|
|Functional
|[[Irritable bowel syndrome]]
| -
| -
|
[[Abdominal pain]] or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:
* Improves with [[defecation]]
* Onset associated with change in frequency of [[stool]]
* Onset associated with change in appearance of stool
* 25% of [[Bowel movement|bowel movements]] are loose stools
History of straining is also common
|
* [[Abdominal tenderness]]
* Hard stool in the rectal vault
|
* [[Diagnosis|Clinical diagnosis]]
** ROME III criteria
** [[Pharmacological|Pharmacologic]] studies based criteria
|
* High [[dietary fiber]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|}{{WikiDoc Help Menu}} {{WikiDoc Sources}}
<small>


==References==
==References==

Revision as of 17:49, 26 July 2017

Lactose Intolerance Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lactose Intolerance from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating Lactose intolerance from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating Lactose intolerance from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating Lactose intolerance from other diseases

CDC on Differentiating Lactose intolerance from other diseases

Differentiating Lactose intolerance from other diseases in the news

Blogs on Differentiating Lactose intolerance from other diseases

Directions to Hospitals Treating Lactose intolerance

Risk calculators and risk factors for Differentiating Lactose intolerance from other diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The differential diagnosis must distinguish lactose intolerance from milk allergy, which is an abnormal immune response (usually) to milk proteins.

Differentiating Lactose Intolerance from other Diseases

The table below summarizes the findings that differentiate watery causes of chronic diarrhea[1][2][3][4]

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50 mOsm per kg > 50 mOsm per kg*
Watery Secretory Crohns + -
Hyperthyroidism + -
VIPoma + -
  • Elevated VIP levels
  • Followed by imaging
Osmotic Lactose intolerance - +
Celiac disease - +
Functional Irritable bowel syndrome - -

Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:

  • Onset associated with change in frequency of stool
  • Onset associated with change in appearance of stool

History of straining is also common

Template:WikiDoc Sources

References

  1. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  2. ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  3. ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
  4. ↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
Retrieved from "https://www.wikidoc.org/index.php?title=Differentiating_Lactose_intolerance_from_other_diseases&oldid=1330569"