Differentiating Lactose intolerance from other diseases

Jump to navigation Jump to search

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

Overview

Lactose intolerance must be differentiated from other diseases that cause diarrhea such as pancreatic insufficiency, irritable bowel syndrome, small intestinal bacterial overgrowth, celiac disease, and inflammatory bowel disease[1][2][3]

Differentiating lactose intolerance from other Diseases

  • Lactose intolerance must be differentiated from other diseases that cause diarrhea such as pancreatic insufficiency, irritable bowel syndrome, small intestinal bacterial overgrowth, celiac disease, and inflammatory bowel disease[1][2][3]
  • Lactose intolerance must be differentiated from other causes that produce bloating and flatulence such as beans that contain stachyose and raffinose, two indigestible sugars.[4]


References

  1. 1.0 1.1 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.
  2. 2.0 2.1 Suchy FJ, Brannon PM, Carpenter TO, Fernandez JR, Gilsanz V, Gould JB, Hall K, Hui SL, Lupton J, Mennella J, Miller NJ, Osganian SK, Sellmeyer DE, Wolf MA (2010). "National Institutes of Health Consensus Development Conference: lactose intolerance and health". Ann. Intern. Med. 152 (12): 792–6. doi:10.7326/0003-4819-152-12-201006150-00248. PMID 20404261.
  3. 3.0 3.1 Novillo A, Peralta D, Dima G, Besasso H, Soifer L (2010). "[Frequency of bacterial overgrowth in patients with clinical lactose intolerance]". Acta Gastroenterol. Latinoam. (in Spanish; Castilian). 40 (3): 221–4. PMID 21053480.
  4. Suarez FL, Levitt MD (2000). "An understanding of excessive intestinal gas". Curr Gastroenterol Rep. 2 (5): 413–9. PMID 10998670.

Template:WH Template:WS 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.