Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Oct 31:9:82.
doi: 10.1186/1471-230X-9-82.

A comparison of diagnostic tests for lactose malabsorption--which one is the best?

Øistein Hovde  1 , Per G Farup
Affiliations
Comparative Study

A comparison of diagnostic tests for lactose malabsorption--which one is the best?

Øistein Hovde et al. BMC Gastroenterol. .

Abstract

Background: Perceived milk intolerance is a common complaint, and tests for lactose malabsorption (LM) are unreliable. This study assesses the agreement between diagnostic tests for LM and describes the diagnostic properties of the tests.

Methods: Patients above 18 years of age with suspected LM were included. After oral intake of 25 g lactose, a combined test with measurement of serum glucose (s-glucose) and hydrogen (H2) and methane (CH4) in expired air was performed and symptoms were recorded. In patients with discrepancies between the results, the combined test was repeated and a gene test for lactose non-persistence was added. The diagnosis of LM was based on an evaluation of all tests. The following tests were compared: Increase in H2, CH4, H2+CH4 and H2+CH4x2 in expired air, increase in s-glucose, and symptoms. The agreement was calculated and the diagnostic properties described.

Results: Sixty patients were included, seven (12%) had LM. The agreement (kappa-values) between the methods varied from 0.25 to 0.91. The best test was the lactose breath test with measurement of the increase in H2 + CH4x2 in expired air. With a cut-off level < 18 ppm, the area under the ROC-curve was 0.967 and sensitivity was 100%. This shows that measurement of CH4 in addition to H2 improves the diagnostic properties of the breath test.

Conclusion: The agreement between commonly used methods for the diagnosis of LM was unsatisfactory. A lactose breath test with measurement of H2 + CH4x2 in expired air had the best diagnostic properties.

PubMed Disclaimer

References

    1. Vesa TH, Marteau P, Korpela R. Lactose intolerance. J Am Coll Nutr. 2000;19:165S–175S. - PubMed
    1. Farup PG, Monsbakken KW, Vandvik PO. Lactose malabsorption in a population with irritable bowel syndrome: Prevalence and symptoms. A case-control study. Scand J Gastroenterol. 2004;39:645–649. doi: 10.1080/00365520410005405. - DOI - PubMed
    1. Almon R, Engfeldt P, Tysk C, Sjöström M, Nilsson TK. Prevalence and trends in adult-type hypolactasia in different age cohorts in Central Sweden diagnosed by genotyping for the adult-type hypolactasia-linked LCT-13910C>T mutation. Scand J Gastroenterol. 2007;42:165–170. doi: 10.1080/00365520600825257. - DOI - PubMed
    1. Vesa TH, Seppo LM, Marteau PR, Sahi T, Korpela R. Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr. 1998;67:710–715. - PubMed
    1. Simrén M, Månsson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U. et al.Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63(2):108–115. doi: 10.1159/000051878. - DOI - PubMed

Publication types