- Gastrointestinal disorders in secondary lactase deficiency: diagnostic features, methods of correction
Gastrointestinal disorders in secondary lactase deficiency: diagnostic features, methods of correction
Modern Pediatrics. Ukraine. (2024). 4(140): 64-72. doi: 10.15574/SP.2024.140.64
Marushko Yu. V.1, Marushko T. V.2, Dmytryshyn O. A.1, Iovitsa T. V.1, Bovkun O. A.1
1Bogomolets National Medical University, Kyiv, Ukraine
2Shupyk National Healthcare University of Ukraine, Kyiv
For citation: Marushko YuV, Marushko TV, Dmytryshyn OA, Iovitsa TV, Bovkun OA. (2024). Gastrointestinal disorders in secondary lactase deficiency: diagnostic features, methods of correction. Modern Pediatrics. Ukraine. 4(140): 64-72. doi: 10.15574/SP.2024.140.64.
Article received: Mar 08, 2024. Accepted for publication: May 14, 2024.
A modern problem of practical pediatrics is secondary lactase deficiency – intolerance to dairy products containing lactose, which develops in response to a decrease in lactase activity due to enterocyte damage in an infectious, allergic, or other inflammatory process in the intestine, atrophic changes in the intestinal mucosa, and antibacterial drugs. Secondary lactase deficiency leads to flatulence, abdominal pain, and diarrhea – clinical manifestations that impair the quality of life and slow down the recovery process. An important aspect is the differential diagnosis of secondary lactase deficiency and organic and functional diseases of the gastrointestinal tract.
The aim of the study is to summarize the literature data on the features of the clinical picture, diagnosis, and methods of correction of secondary lactase deficiency in children.
According to the literature review, it is known that lactase deficiency can be primary or secondary and manifest clinically in both children and adults. There are various etiologic factors for the development of secondary lactase deficiency, which defines it as an urgent problem in pediatrics and a common cause of dyspeptic and abdominal syndrome in children. The clinical manifestations of secondary lactase deficiency are nonspecific and similar to the signs of organic and functional gastrointestinal diseases. The severity of the manifestations depends on the amount of lactose consumed and the level of lactase activity. Diagnostics of secondary lactase deficiency involves the use of invasive and non-invasive research methods, among which the leading role belongs to the hydrogen breathing test with a load of food lactose. Modern methods of treating secondary lactase deficiency include the administration of enzyme replacement therapy – lactase, the use of which will allow preserved breastfeeding for young children and rational nutrition for older children.
The authors declare no conflict of interest.
Keywords: primary lactase deficiency, secondary lactase deficiency, hydrogen breath test, diarrhea, dysbiosis, stool test, functional dyspepsia, irritable bowel syndrome.
REFERENCES
1. Brüssow H. (2013). Nutrition, population growth and disease: a short history of lactose. Environmental microbiology. 15(8): 2154-2161. https://doi.org/10.1111/1462-2920.12117; PMid:23574334
2. Cain GD, Reiner EB, Patterson M. (1968). Effects of neomycin on disaccharidase activity of the small bowel. Archives of internal medicine. 122(4): 311-314. https://doi.org/10.1001/archinte.122.4.311; PMid:5676416
3. Casellas F, Aparici A, Pérez MJ, Rodríguez P. (2016). Perception of lactose intolerance impairs health-related quality of life. European journal of clinical nutrition. 70(9): 1068-1072. https://doi.org/10.1038/ejcn.2016.80; PMid:27188918
4. Catanzaro R, Sciuto M, Singh B, Pathak S, Marotta F. (2021). Irritable bowel syndrome and lactose intolerance: the importance of differential diagnosis. A monocentric study. Minerva gastroenterology. 67(1): 72-78. https://doi.org/10.23736/S2724-5985.20.02734-8; PMid:32623873
5. Di Costanzo M, Berni Canani R. (2018). Lactose Intolerance: Common Misunderstandings. Annals of nutrition & metabolism. 73; Suppl 4: 30-37. https://doi.org/10.1159/000493669; PMid:30783042
6. Evans J, Hanoodi M, Wittler M. (2023) Amoxicillin Clavulanate. [Updated 2023 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. URL: https://www.ncbi.nlm.nih.gov/books/NBK538164/.
7. Feinle-Bisset C, Azpiroz F. (2013). Dietary and lifestyle factors in functional dyspepsia. Nature reviews. Gastroenterology & hepatology. 10(3): 150-157. https://doi.org/10.1038/nrgastro.2012.246; PMid:23296252
8. Forsgård RA. (2019). Lactose digestion in humans: intestinal lactase appears to be constitutive whereas the colonic microbiome is adaptable. The American journal of clinical nutrition. 110(2): 273-279. https://doi.org/10.1093/ajcn/nqz104; PMid:31175813 PMCid:PMC6669050
9. Hammer HF, Högenauer C. (2022). Lactose intolerance and malabsorption: Clinical manifestations, diagnosis, and management. Waltham (MA): UpToDate, 11.
10. Hammer HF, Högenaue C. (2018). Lactose intolerance: Clinical manifes-tations, diagnosis, and management [Internet]. URL: https://uptodate-free.ir/topic.htm?-path=lactose-intoler-ance-clinical-manifestations-diagnosis-and-management.
11. Harvey L, Ludwig T, Hou AQ, Hock QS, Tan ML, Osatakul S et al. (2018). Prevalence, cause and diagnosis of lactose intolerance in children aged 1-5 years: a systematic review of 1995-2015 literature. Asia Pacific journal of clinical nutrition. 27(1): 29-46. https://doi.org/10.6133/apjcn.022017.05.
12. Heyman MB, Committee on Nutrition. (2006). Lactose intolerance in infants, children, and adolescents. Pediatrics. 118(3): 1279-1286. https://doi.org/10.1542/peds.2006-1721; PMid:16951027
13. Hutyra T, Iwańczak B. (2009, Feb). Lactose intolerance: pathophysiology, clinical symptoms, diagnosis and treatment. Pol Merkur Lekarski. 26(152): 148-152. PMID: 19388523.
14. Hu Y, Gui L, Chang J, Liu J, Xu S, Deng C et al. (2016). The incidence of infants with rotavirus enteritis combined with lactose intolerance. Pakistan journal of pharmaceutical sciences. 29; 1 Suppl: 321-323.
15. ACG. (2024). Lactose Intolerance. American College of Gastroenterology. URL: https://gi.org/topics/lactose-intolerance-in-children/.
16. Lenfestey MW, Neu J. (2018). Gastrointestinal Development: Implications for Management of Preterm and Term Infants. Gastroenterology clinics of North America. 47(4): 773-791. https://doi.org/10.1016/j.gtc.2018.07.005; PMid:30337032
17. Leseva MN, Grand RJ, Klett H, Boerries M, Busch H et al. (2018). Differences in DNA Methylation and Functional Expression in Lactase Persistent and Non-persistent Individuals. Scientific reports. 8(1): 5649. https://doi.org/10.1038/s41598-018-23957-4; PMid:29618745 PMCid:PMC5884863
18. Levitt M, Wilt T, Shaukat A. (2013). Clinical implications of lactose malabsorption versus lactose intolerance. Journal of clinical gastroenterology. 47(6): 471-480. https://doi.org/10.1097/MCG.0b013e3182889f0f; PMid:23632346
19. Lindberg G, Mohammadian G. (2023). Loose ends in the differential diagnosis of IBS-like symptoms. Frontiers in medicine. 10: 1141035. https://doi.org/10.3389/fmed.2023.1141035; PMid:37484861 PMCid:PMC10357384
20. Long CX, He L, Guo YF, Liu YW, Xiao NQ, Tan ZJ. (2017). Diversity of bacterial lactase genes in intestinal contents of mice with antibiotics-induced diarrhea. World journal of gastroenterology. 23(42): 7584-7593. https://doi.org/10.3748/wjg.v23.i42.7584; PMid:29204058 PMCid:PMC5698251
21. Lukito W, Malik SG, Surono IS, Wahlqvist ML. (2015). From 'lactose intolerance' to 'lactose nutrition'. Asia Pacific journal of clinical nutrition. 24; Suppl 1: S1-S8. https://doi.org/10.6133/apjcn.2015.24.s1.01.
22. Malik TF, Panuganti KK. (2023) Lactose Intolerance. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. URL: https://www.ncbi.nlm.nih.gov/books/NBK532285/.
23. Martínez Vázquez SE, Nogueira de Rojas JR, Remes Troche JM, Coss Adame E, Rivas Ruíz R, Uscanga Domínguez LF. (2020). The importance of lactose intolerance in individuals with gastrointestinal symptoms. Importancia de la intolerancia a la lactosa en individuos con síntomas gastrointestinales. Revista de gastroenterologia de Mexico (English). 85(3): 321-331. https://doi.org/10.1016/j.rgmx.2020.03.002; PMid:32482516
24. Marushko YuV, Asonov AO. (2017). Use of a multi-species probiotic Probiz for the prevention of antibiotic-associated diarrhea. Sovremennaya pediatriya. 3(83): 62-67.
25. Marushko YuV, Hrachova MH, Iovitsa TV. (2015). Aktualni pytannia diahnostyky ta terapii vtorynnoi laktaznoi nedostatnosti u ditei. Sovremennaia pedyatryia. 1(65): 110-114.
26. Marushko Y, Hyshchak T, Pysariev A, Iovitsa T. (2023). Use of Saccharomyces boulardii to Prevent Antibiotic-associated Diarrhea in Children with Pneumonia and Bronchitis. Family Medicine. European Practices. (3): 55-62. https://doi.org/10.30841/2786-720X.3.2023.289354
27. Marushko YuV, Iovitsa TV. (2016). Pidkhody do terapii tranzytornoi laktaznoi nedostatnosti u ditei hrudnoho viku. Sovremennaya pediatriya. (2): 26-30.
28. Marushko YuV, Iovitsa TV. (2013). Osoblyvosti diahnostyky ta terapii kyshkovykh kolok, obumovlenykh laktaznoiu nedostatnistiu, u ditei hrudnoho viku. Sovremennaya pediatriya. (3): 51-60.
29. Marushko YuV, Iovitsa TV, Todyka YuI. (2016). Kliniko-laboratorna kharakterystyka laktaznoi nedostatnosti u ditei hrudnoho viku. Sovremennaya pediatriya. (7): 98-101.
30. Marushko Y, Yesypova S. (2023). The Problem of Lactase Deficiency: Diagnosis and Treatment Approaches in Children. Family Medicine. European Practices. (3): 29-34. https://doi.org/10.30841/2786-720X.3.2023.289337
31. Micic D, Rao VL, Rubin DT. (2019). Clinical Approach to Lactose Intolerance. JAMA. 322(16): 1600-1601. https://doi.org/10.1001/jama.2019.14740; PMid:31556907
32. Misselwitz B, Butter M, Verbeke K, Fox MR. (2019). Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 68(11): 2080-2091. https://doi.org/10.1136/gutjnl-2019-318404; PMid:31427404 PMCid:PMC6839734
33. Misselwitz B, Pohl D, Frühauf H, Fried M, Vavricka SR, Fox M. (2013). Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European gastroenterology journal. 1(3): 151-159. https://doi.org/10.1177/2050640613484463; PMid:24917953 PMCid:PMC4040760
34. Nezghoda II, Naumenko OM, Asaulenko AA, Onofriichuk OS, Yuzhanina VM, Brovinska, LM et al. (2015). Efektyvnist zastosuvannia krapelnoi formy fermentu laktazy Mamalak pry rotavirusnii infektsii u ditei. Sovremennaya pedyatriya. (1): 102-109.
35. Nezghoda II, Naumenko OM, Makukh HV, Buk AYa. (2013). Henetychni aspekty v patohenezi rotavirusnoi infektsii v ditei. Zdorove rebenka. 5: 131-135. https://doi.org/10.22141/2224-0551.5.48.2013.84825
36. Romero-Velarde E, Delgado-Franco D, García-Gutiérrez M, Gurrola-Díaz C, Larrosa-Haro A et al. (2019). The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting. Nutrients. 11(11): 2737. https://doi.org/10.3390/nu11112737; PMid:31718111 PMCid:PMC6893676
37. Schmulson MJ, Drossman DA. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility. 23(2): 151-163. https://doi.org/10.5056/jnm16214; PMid:28274109 PMCid:PMC5383110
38. Shadrin OH, Khomutovska KO. (2014). Kyshkovi koliky u ditei rannoho viku pry riznykh typakh laktaznoi nedostatnosti, osoblyvosti diahnostyky ta korektsii. Sovremennaya pedyatriya. (6): 102-107.
39. Shadrin OH, Khomutovska KO. (2014). Problemy diahnostyky laktaznoi nedostatnosti u ditei rannoho viku. Dytiachyi likar. 34(5): 5-9.
40. Sharikadze O. (2022). Malabsorption and lactose intolerance: pathophysiology, diagnosis and treatment of pathogenesis. World Science. 3(75). https://doi.org/10.31435/rsglobal_ws/30042022/7804
41. Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA et al. (2010). Systematic review: effective management strategies for lactose intolerance. Annals of internal medicine. 152(12): 797-803. https://doi.org/10.7326/0003-4819-152-12-201006150-00241; PMid:20404262
42. Shulman RJ, Schanler RJ, Lau C, Heitkemper M, Ou CN, Smith EO. (1998). Early feeding, feeding tolerance, and lactase activity in preterm infants. The Journal of pediatrics. 133(5): 645-649. https://doi.org/10.1016/S0022-3476(98)70105-2; PMid:9821422
43. Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H et al. (2016). Gastroduodenal disorders. Gastroenterology. 150(6): 1380-1392. https://doi.org/10.1053/j.gastro.2016.02.011; PMid:27147122
44. Storhaug CL, Fosse SK, Fadnes LT. (2017). Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. The lancet. Gastroenterology & hepatology. 2(10): 738-746. https://doi.org/10.1016/S2468-1253(17)30154-1; PMid:28690131
45. Szilagyi A, Ishayek N. (2018). Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 10(12): 1994. https://doi.org/10.3390/nu10121994; PMid:30558337 PMCid:PMC6316316
46. Toca MDC, Fernández A, Orsi M, Tabacco O, Vinderola G. (2022). Lactose intolerance: myths and facts. An update. Intolerancia a la lactosa: mitos y verdades. Actualización. Archivos argentinos de pediatria. 120(1): 59-66. https://doi.org/10.5546/aap.2022.eng.59
47. Usachova OV, Tarasenko NV. (2014). Mistse laktaznoi nedostatnosti v patohenezi rotavirusnoi infektsii ta mozhlyvosti yii korektsii. Zaporozhskyi medytsynskyi zhurnal. (4): 45-49.
48. Varjú P, Gede N, Szakács Z, Hegyi P, Cazacu IM, Pécsi D et al. (2019). Lactose intolerance but not lactose maldigestion is more frequent in patients with irritable bowel syndrome than in healthy controls: A meta-analysis. Neurogastroenterology and motility. 31(5): e13527. https://doi.org/10.1111/nmo.13527; PMid:30560578 PMCid:PMC7379306
49. Wortmann AC, Simon D, Mazzoleni LE, Sander GB, Francesconi CFM, Nabinger DD et al. (2018). The association between adult-type hypolactasia and symptoms of functional dyspepsia. Genetics and molecular biology. 41(1): 92-97. https://doi.org/10.1590/1678-4685-gmb-2017-0015; PMid:29384557 PMCid:PMC5901505
50. Yesypova SI, Dmytryshyn BYa, Bovkun OA, Dmytryshyn OA. (2018). Pediatrychni kryterii Rymu IV: zminy ta porivniannia z Rymskymy kryteriiamy III. Semeinaia medytsyna. (1): 20-23.