Lactose intolerance diagnostic study of choice
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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
- The page name should be "Diagnostic study of choice for [disease name]", with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
- Goal:
- To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
- To describe the gold standard test for the diagnosis of [disease name].
- To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
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Diagnostic Study of Choice
Gold standard/Study of choice:
Small bowel biopsy
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Lactose Intolerance Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Lactose intolerance diagnostic study of choice On the Web |
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American Roentgen Ray Society Images of Lactose intolerance diagnostic study of choice |
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Risk calculators and risk factors for Lactose intolerance diagnostic study of choice |
- Small bowel biopsy such as jujenal or deodenal biopsy is the gold standard test for the diagnosis of lactose intolerance via investigation of lactase enzyme activity.[1][2]
- Low lactase activity in small bowel biopsy is confirmatory of lactose intolerance.
- Distinguishes between primary and secondary lactase deficiency by evaluation of small bowel histology.
- Nowadays, small bowel biposy is rarely performed and it is substitued with noninvasive diagnostic tests such as lactose tolerance test and lactose breath hydrogen test.
Lactose breath hydrogen test
- The diagnostic study of choice for lactose intolerance is lactose breath hydrogen test. Following are a few important aspects related to lactose breath hydrogen test:[3][4]
- It is a noninvasive investigation
- 50 g of lactose in water ( the equivalent of that in 1 L of milk) and 2 g/kg of lactose (maximum dose 25 g) in children in fasting state is administered[5]
- Breath hydrogen level and associated symtoms such as bloating, diarrhea and abdominal pain are checked at baseline and at 30 minute intervals for three hours
- Lactose malabsorption and intolerance are diagnosed based on a rise in hydrogen concentration of 20 ppm ( parts per million) and persentation of symptoms in compare to baseline
- Undigested lactose is fermented by intestinal flora to carbon dioxide, hydrogen and methane and then they are eliminated via the lungs.
- False negative result is due to:
- Taking antibiotics within previous one month
- Inhibition of bacterial activity by more acidic environment of colon
- Underlying lung disease
- False positive result
- Small bowel bacterial overgrowth:
- Earlier rise in breath hydrogen level after ingestion of lactose ( less than 60 minutues )
- Avoiding cigarette smoking and exercise 2 hours before lactose hydrogen test, because they cause hyperventilation and they can change accuracy of test[6]
- Small bowel bacterial overgrowth:
The comparison table for diagnostic studies of choice for lactose intolerance[7][8][9]
| Namee of Investigation | Sensitivity | Specificity |
|---|---|---|
| Lactose breath hydrogen test | 88 | 85 |
| Genetic test for primary lactase deficiency | 88 | 90 |
| Endoscopic duodenal biopsy | 95 | 100 |
| Lactose tolearance test | 94 | 90 |
Diagnostic Criteria
- Here you should describe the details of the diagnostic criteria.
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- Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
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- [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
- There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
- [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
IF there are clear, established diagnostic criteria:
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
- The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
- There are no established criteria for the diagnosis of lactose intolerance. However, investigations such as lactose breath test can be very helpful in the diagnosis of lactose intolerance.
References
- ↑ 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.
- ↑ Scrimshaw NS, Murray EB (1988). "The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance". Am. J. Clin. Nutr. 48 (4 Suppl): 1079–159. PMID 3140651.
- ↑ Law D, Conklin J, Pimentel M (2010). "Lactose intolerance and the role of the lactose breath test". Am. J. Gastroenterol. 105 (8): 1726–8. doi:10.1038/ajg.2010.146. PMID 20686460.
- ↑ Ghoshal UC (2011). "How to interpret hydrogen breath tests". J Neurogastroenterol Motil. 17 (3): 312–7. doi:10.5056/jnm.2011.17.3.312. PMC 3155069. PMID 21860825.
- ↑ Scrimshaw NS, Murray EB (1988). "The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance". Am. J. Clin. Nutr. 48 (4 Suppl): 1079–159. PMID 3140651.
- ↑ Ghoshal UC, Ghoshal U, Das K, Misra A (2006). "Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time". Indian J Gastroenterol. 25 (1): 6–10. PMID 16567886.
- ↑ Kuokkanen M, Myllyniemi M, Vauhkonen M, Helske T, Kääriäinen I, Karesvuori S, Linnala A, Härkönen M, Järvelä I, Sipponen P (2006). "A biopsy-based quick test in the diagnosis of duodenal hypolactasia in upper gastrointestinal endoscopy". Endoscopy. 38 (7): 708–12. doi:10.1055/s-2006-925354. PMID 16761211.
- ↑ Marton A, Xue X, Szilagyi A (2012). "Meta-analysis: the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C/T-13910". Aliment. Pharmacol. Ther. 35 (4): 429–40. doi:10.1111/j.1365-2036.2011.04962.x. PMID 22211845.
- ↑ 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.