Differentiating Lactose intolerance from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating lactose intolerance from other Diseases

  • Lactose intoelrance must be differentiated from other diseases that cause diarrhea such as pancreatic insufficiency, short bowel syndrome, villous atrophy, irritable bowel syndrome, cow’s milk protein allergy, bacterial overgrowth, celiac disease, and inflammatory bowel disease[1]
  • Lactose intoelrance must be differentiated from irritable bowel syndrome and cow’s milk protein allergy, bacterial overgrowth, celiac disease, and inflammatory bowel disease
  • [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
  • As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Preferred Table

Diseases History and Symptoms Physical Examination Laboratory Findings Other Findings
Finding

1

Finding 2 Finding 3 Finding

4

Physical Finding 1 Physical Finding 2 Physical Finding 3 Physical Finding 4 Lab Test 1 Lab Test 2 Lab Test 3 Lab Test 4
Differential Diagnosis 1 +
Differential Diagnosis 2 -
Differential Diagnosis 3
Differential Diagnosis 4
Differential Diagnosis 5

Use if the above table can not be made

Differential Diagnosis Similar Features Differentiating Features
Differential 1
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].

References

  1. Mattar R, de Campos Mazo DF, Carrilho FJ (2012). "Lactose intolerance: diagnosis, genetic, and clinical factors". Clin Exp Gastroenterol. 5: 113–21. doi:10.2147/CEG.S32368. PMC 3401057. PMID 22826639.

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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. [3]

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


The table below summarizes the findings that differentiate fatty causes of chronic diarrhea[5][6][7]

Cause Osmotic gap History Physical exam Gold standard Treatment
< 50

mOsm

per kg

> 50

mOsm

per kg*

lactose intolerance - + Lactose breath hydrogen test Restriction of lactose and maintain calcium and vitamin D intake.
Celiac sprue - + Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. Dietary counseling, elimination of gluten in the diet.
Whipple disease - + Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry) Doxycycline and hydroxychloroquine are bactericidal

Lactose intolerance must be differentiated from diseases that cause abdominal pain and chronic diarrhea. The table below summarizes the findings that differentiate watery causes of chronic diarrhea:[8][1][2][3][4]

Cause Osmotic gap History Physical exam Gold standard for diagnosis
< 50 mOsm per kg > 50 mOsm per kg*
Zollinger-Ellison syndrome + - Gastrin levels
Crohn's disease + -
Hyperthyroidism + -
VIPoma + -
  • Elevated VIP levels
  • Followed by imaging
Lactose intolerance - +
Celiac disease - +
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.

References

  1. 1.0 1.1 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. 2.0 2.1 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. 3.0 3.1 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. 4.0 4.1 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.
  5. Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
  6. Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
  7. BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.
  8. SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.