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Query: KEGG:D00046 (lactose)
 16,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intolerance to certain foods can cause a range of gut and systemic symptoms. The possibility that these can be caused by lactose has been missed because of "hidden" lactose added to many foods and drinks inadequately labelled, confusing diagnosis based on dietary removal of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance. The key is the prolonged effect of dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of "risk" foods, inadequately labelled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the wide range of systemic symptoms caused by lactose intolerance. This has important implications for the management of irritable bowel syndrome, and for doctors of many specialties.
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PMID:Systemic lactose intolerance: a new perspective on an old problem. 1574 92

Irritable bowel syndrome (IBS) is one of the most common 'functional' gastrointestinal disorders accounting for 3% of all primary care consultations, with a strong female predominance. Although most of the literature comes from Western industrialized societies, when it has been looked for, this disorder appears to be equally common in the Third World. It is characterized by chronic abdominal pain or discomfort associated with disordered bowel habit and visceral hypersensitivity. Anxiety and somatization are more common in IBS than in the general population and may encourage consultation; however, they correlate poorly with symptoms. Bacterial gastroenteritis may be followed by the development of IBS in 5-10% of patients, depending on the severity of initial illness and prior anxiety or depression. The Rome criteria allow reliable diagnosis provided that there are no 'alarm' features which mandate further investigation. Microscopic colitis and bile salt malabsorption can easily be mistaken for IBS, as can chronic infestations or infections which should be considered, while recognizing that these are extremely uncommon in westernized societies. Some patients respond to exclusion diets as lactose and wheat intolerance are common. Others with prominent anxiety and/or depression respond to psychotherapy or antidepressants. Diarrhoeal symptoms respond to loperamide and 5HT3 receptor antagonists, while constipation responds to 5HT4 agonists. Antispasmodics may have limited benefit in treating pain. Low-dose tricyclic antidepressants are also helpful in alleviating pain and anxiety, even in those without obvious psychiatric disorders. If diagnostic criteria are met, then once diagnosed, new diagnoses rarely appear.
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PMID:Irritable bowel syndrome. 1576 61

Enteral nutrition therapy with liquid diet has been shown to be effective in achieving clinical remission in intestinal Crohn's disease. The mechanism of action of this therapy, however, is still poorly understood. As part of our assessment of the action of 3 related polymeric enteral therapies, we have used a variety of techniques to document the histological and cytokine responses, in the mucosa and, systemically, to these treatments. The feeds studied (AL110, Modulen IBD and ACD004 [Nestle, Vevey, Switzerland]) all have casein as the protein source, are lactose free and are rich in transforming growth factor beta (TGF-beta). They have all been shown to induce clinical remission associated with mucosal healing. In the case of Modulen IBD, as well as mucosal macroscopic and histological healing there was a fall in mucosal proinflammatory cytokines: interleukin-1 mRNA in colonic and ileal, interleukin-8 mRNA in the colon and interferon gamma mRNA in the ileum, but a rise in the regulatory cytokine TGF-beta mRNA in the ileum. These results indicate that these formulas are influencing the disease process itself, and thus suggest that the clinical remission achieved is a result of a reduction in inflammation, rather than a consequence of some other nutrition effect.
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PMID:Control of systemic and local inflammation with transforming growth factor beta containing formulas. 1598 Feb 74

Because of the wide variations in the clinical presentation of celiac disease and because treatment exists that is effective in most cases, screening of the general population for celiac disease has been considered. There is still no evidence that patients who have symptom-free celiac disease are at increased risk of small intestinal lymphoma or other complications. Prevention of osteoporosis seems to be the strongest indicator for widespread screening today [22]. The major cause of failure to respond to a gluten-free diet is continuing ingestion of gluten, but other underlying diseases must be considered. Many different drugs (eg, anti-tumor necrosis factor [TNF]-alpha) have been used in patients who have RCD [23]. Steroid treatment has been reported to be effective even in patients who have underlying early EATL. Histologic recovery in patients who have celiac disease usually takes several months but can take up to 1 year, even if the patient remains on a strict gluten-free diet. Some patients report celiac-related symptoms for months after a single gluten intake. The definitions for RCD in literature vary. The authors consider the definition give by Daum and colleagues [24] suitable. They defined true RCD as villous atrophy with crypt hyperplasia and increased IELs persisting for more than 12 months in spite of a strict gluten-free diet. If a patient is not responding well to a gluten-free diet, three considerations are necessary: (1) the initial diagnosis of celiac disease must be reassessed;(2) the patient should be sent to a dietician to check for errors in diet or compliance problems, because problems with the gluten-free diet are the most important cause for persisting symptoms; (3) other reasons for persisting symptoms (eg, pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, protein-losing enteropathy,T-cell lymphoma, fructose intolerance, cavitating lymphadenopathy, and tropical sprue) should be considered. Other causes for villous atrophy are Crohn's disease, collagenous sprue, and autoimmune enteropathy. Abdulkarim and colleagues [25] examined 55 patients who had a diagnosis of nonresponsive celiac disease. He found that 6 did not have celiac disease, and25 still had some gluten ingestion.Tursi and colleagues [26] reported 15 patients who had celiac disease with persisting symptoms. Because histology improved in all patients after several months, RCD was excluded. Of the 15 patients, 10 had small intestinal bacterial overgrowth, 2 showed lactose malabsorption causing the described symptoms, 1 had mistakenly taken an antibiotic containing gluten, and 1 patient each had Giardia lamblia and Ascaris lumbricoides. Thus, other entities must be considered in patients who have celiac disease and ongoing symptoms. In a follow-up clinical trial, 158 patients who had celiac disease underwent follow-up small intestine biopsies within 2 years after starting a gluten-free diet. Eleven patients (7.0%) with persisting (partial) villous atrophy were considered to have RCD; 5 of them developed EATL [27].RCD type I is characterized by normal expression of T-cell antigens and polyclonal TCR gene rearrangement.RCD type II is characterized by an abnormal IEL phenotype with the expression of intracytoplasmic CD3e, surface CD103, and the lack of classic surface T-cell markers such as CD8, CD4, and TCR-alpha/beta. This clonal IEL population can be considered crypt IEL [24]. RCD II has a poor prognosis, which is a problem for therapy. Clonal TCR gene rearrangements and loss of T-cell antigens such as CD8 and TCR-beta in IELs may indicate the development of an EATL in patients who have RCD. The markers for an overt EATL are a positive stool blood test, increased lactate dehydrogenase, or beta2-microglobulin [24]. If an overt lymphoma is suspected, upper and lower endoscopy, an ear, nose, and throat work-up, CT scan, capsule endoscopy, and possibly double-balloon enteroscopy should be performed. Most reports of the difficulties in treating patients who have true RCE are casereports. Turner and colleagues [28] reported on an induction of remission by useof the anti-TNF-alpha antibody infliximab and maintenance with prednisoloneand azathioprine. Olaussen and colleagues [29] and Mandal and colleagues [30]tried a nonimmunogenic elemental diet. Gillet and colleagues [31] reported successful treatment of a patient who hadRCD using anti-TNF-alpha antibodies (infliximab) for induction and azathioprinefor maintenance. Maurino and colleagues [32] studied seven consecutive patients diagnosed ashaving refractory sprue and no response to oral or parenteral steroids. Aftertreatment with azathioprine (2 mg/kg/d) and oral prednisone (1 mg/kg/d), fivepatients had a complete clinical remission. Two patients who did not respond totreatment at any time died. Goerres and colleagues [33] described 18 patients who had RCD, 10 of whomhad type I RCD, and 8 of whom had type II RCD. Treatment consisted ofazathioprine combined with prednisone for 1 year. Consistent with reports byother investigators, the response rates in the two groups differed. Eight of the10 patients who had type I RCD had a histologic response. Seven of the eightpatients who had type II RCD died, and six of the eight developed a lymphoma. At present there is no effective treatment for type II RCD.Fig. 3 presents a proposed algorithm for monitoring patients who have ce-liac disease.
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PMID:Monitoring nonresponsive patients who have celiac disease. 1687 29

Patients complaining of 'chronic diarrhoea' usually mean the passage of loose, urgent stools. Chronic diarrhoea is a feature of malabsorption; it may also be seen in the 'dumping syndrome' which follows gastric surgery, small intestinal bacterial overgrowth, bile salt malabsorption and in malabsorption of simple sugars including most commonly lactose, fructose and sorbitol. Excessively rapid entry of chyme into the small or large intestine generates propulsive motor patterns leading to accelerated transit. Inflammation is associated with decreased normal mixing motor patterns but increased propulsive motility including high amplitude propagated contractions (HAPCs). Evidence for abnormal small intestinal motility in the diarrhoea associated with irritable bowel syndrome (IBS) is conflicting and any difference appears small. Increased colonic HAPCs with increased propulsion is seen in IBS with diarrhoea (IBS-D). Stress-induced colonic motility is increased in IBS-D with hyper-responsiveness to corticotrophin releasing factor (CRF). Long-lasting increases in mucosal serotonin availability may contribute to the chronic diarrhoea seen in IBS-D and coeliac disease. Treatments for abnormal motility in chronic diarrhoea include those designed to correct specific underlying abnormalities including octreotide, antibiotics, colestyramine, specific food avoidance and anti-inflammatory agents. There are also treatments aimed primarily at altering motility directly including opiates, 5HT3 receptor antagonists and amitriptyline.
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PMID:Role of motility in chronic diarrhoea. 1710 87

Dairy foods (DFs) contain complex ingredients that could affect different diseases. The control of lactose digestion phenotypically divides populations into those who can [lactase persistent (LP)] and those who cannot [lactase nonpersistent (LNP)] assimilate lactose. LNP subjects, however, can adapt to lactose intolerance through intestinal bacteria. The DF/LNP status interactions may function as disease risk modifiers. We evaluated the relationship between DF and LNP with colorectal, breast, prostate, ovarian, lung, and stomach cancer and inflammatory bowel diseases (IBD; Crohn's disease and ulcerative colitis). Yearly per capita DF consumption, LNP national prevalence, cancer mortality, and incidence of IBD were obtained from several sources. A negative binomial regression model was used to derive incremental risks. There were statistically significant (P <or= 0.05) increases in risk for colorectal and prostate cancer and ulcerative colitis with DFs and a statistically significant decreased risk for stomach cancer. There were trends (P<0.1) for lung and ovarian cancers and Crohn's disease. As LNP prevalence increased, stomach cancer risk increased, whereas risks of all other conditions decreased (P<0.01). In 3 cancers (prostate, ovarian, and breast), meta-analyses of case-based studies support ecological data. In colorectal cancer, on the contrary, meta-analyses of case-based studies suggest protection. The possible importance of distinguishing LNP/LP status in studies is discussed.
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PMID:Impact of lactose containing foods and the genetics of lactase on diseases: an analytical review of population data. 1844 63

The relationship between methanogenic flora and hydrogen (H(2)) production is considered to be a possible confounding factor in the interpretation of hydrogen breath tests (H(2)BT). Therefore, the present study was conducted prospectively and included 154 IBS patients (fulfilling Rome II criteria) and 286 age-and-sex-matched apparently healthy controls. Each subject underwent H(2)BT after overnight fasting using 25 g lactose. Methane and H(2) were measured using an SC Microlyser from Quintron, USA, at baseline and every 30 min for a total of 4 h. Subjects with fasting methane concentration <10 ppm were labeled as low methane producers (LMP) and >10 ppm as predominant methane producers (PMP). A rise >20 ppm over base line in hydrogen concentration was taken as +ve hydrogen breath test. IBS and control groups included 66.78% and 67.53% males, respectively. Mean age in the two groups were 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Hydrogen breath test was +ve in 77/154 (50%) IBS patients and in 142/286 (49.65%) in controls (P > 0.05). It was also observed that the hydrogen breath test was -ve due to PMP in 5/77 (6.49%) of IBS patients and in 29/154 (20.14%) in controls. PMP affected lactose hydrogen breath tests in 6.49-20.14% subjects. This effect is more apparent in apparently healthy subjects as compared to patients with IBS.
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PMID:Effect of predominant methanogenic flora on outcome of lactose hydrogen breath test in controls and irritable bowel syndrome patients of north India. 1900 33

Chronic constipation is one of the most frequent complaints in childhood. Although there is evidence that gastrointestinal flora is important in gut motility, there is little evidence that gut flora is abnormal in constipation. Lactobacilli and bifidobacteria increase stool frequency and decrease consistency in normal individuals. But, according to several reviews, the evidence of probiotics for efficacy in constipation is limited. Fiber supplements, lactose-free diets, and lactobacillus supplementation are effective in the management of children with recurrent abdominal pain and irritable bowel syndrome. Several studies with Lactobacillus GG in children showed negative results in children with chronic constipation. Because Bifidobacterium animalis DN-173 010 has been shown to be effective in adults with constipation-predominant irritable bowel syndrome this study should also be performed in a well-designed large placebo-controlled trial in children with constipation.
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PMID:Probiotics and functional gastrointestinal disorders in children. 1930 Jan 20

Important dietary carbohydrates such as fructose and sorbitol are incompletely absorbed in the normal small intestine. This malabsorption is sometimes associated with abdominal complaints and diarrhea development, symptoms indistinguishable from those of functional bowel disease. Recently, polymerized forms of fructose (fructans) also were implicated in symptom production in patients with irritable bowel syndrome (IBS). Evidence from uncontrolled and controlled challenge studies suggests that malabsorbed sugars (fructose, sorbitol, lactose) and fructans may act as dietary triggers for clinical symptoms suggestive of IBS. Further placebo-controlled studies are needed to obtain definite conclusions about the role of dietary sugar malabsorption in functional bowel disease.
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PMID:Fructose-sorbitol malabsorption. 1976 64

Traveler's diarrhea (TD) strikes 20-60% of travelers visiting developing countries. It occurs shortly after the return and can be distinguished into two categories: acute and persistent TD. Acute TD, mostly caused by bacterial and viral pathogens, is usually mild and self-limited, and deserves empirical symptomatic and/or antibiotic therapy in selected cases. Fluoroquinolones are progressively superseded in this indication by azithromycin, a well tolerated macrolide active against most bacteria responsible for TD, including the quinolone-resistant species of Campylobacter jejuni that are now pervasive, especially in Southeast Asia and India. Persistent TD in the returning traveler is much rarer than its acute counterpart and may be associated with three types of causes. Persistent infections, among which Giardia and possibly Entamoeba predominate, account for a significant proportion of cases. Postinfectious processes represent a second cause and comprise temporary lactose malabsorption and postinfectious irritable bowel syndrome, now considered a major cause of persistent TD. Finally, apparently unrelated chronic diseases causing diarrhea are occasionally unmasked by TD and represent a third type of persistent TD, among which the well established case of incident inflammatory bowel disease poses intriguing pathogenesis questions. This review discusses recent advances in the field and provides practical recommendations for the management of TD in adult, immunocompetent returning travelers.
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PMID:Management of the returning traveler with diarrhea. 2118 May 83


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