Lactose malabsorption and intolerance: current concept, diagnosis, and clinical management
Despite the interest of pediatricians to the issue of lactose malabsorption, there are no common approaches to the management of such patients in Russia. New research data (including those obtained by molecular biology techniques), have required a revision of the terminology. Not all patients with lactose malabsorption have lactose intolerance. Lactose intolerance (presence of objective symptoms) is one clinical variant out of many disorders associated with digestion of lactose; however, it allows accurate identification of patients that require therapy. The biological role of lactose intolerance may vary throughout life and depends on lactase expression, age, nutritional status, specific dairy product, microbiota status, and specific clinical situation. There is an association between physiological aspects of lactose digestion and absorption and the development of the central nervous system, immunity, and microbiota in a child, as well as an association with metabolic and inflammatory diseases such as osteoporosis, vitamin D deficiency, obesity, diabetes, and functional and inflammatory bowel diseases. Currently, blind
testing of lactose malabsorption is preferable due to the shortcomings of existing diagnostic methods (genetic, endoscopic, and functional), although they should be avoided in differential diagnosis. The majority of patients tolerate approximately 25 g of lactose at any time. The development of tolerance over time is not uncommon; it can probably be facilitated by probiotics. The treatment strategy should include a low-lactose diet with monitoring of the effect, lactase supplements, and their gradual cessation when treatment is effective. Any dietary interventions should be used with the consideration of high probability of additional intolerance to other carbohydrates. Somatization and individual visceral sensitivity significantly affect the quality of life of patients and require a separate correction. This literature review discusses the issues of terminology and current views on pathogenesis, diagnosis, and clinical management of patients with lactose malabsorption.
Key words: children, lactose, lactase, lactase deficiency, lactose malabsorption, lactose intolerance, functional and inflammatory gastrointestinal diseases, acute gastroenteritis, intestinal microbiota, lactose-free diet, FODMAP, fermented foods, probiotics, prebiotics, diagnostics, hydrogen respiratory test.
For citation: Meskina E.R. Lactose malabsorption and intolerance: current concept, diagnosis, and clinical management. Vopr. prakt. pediatr. (Clinical Practice in Pediatrics). 2019; 14(5): 39–57. (In Russian).
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