Lactose sensitivity and lactose malabsorption. The two faces of lactose intolerance

Michel Bouchoucha; Marinos Fysekidis; Pierre Rompteaux; Jean-Jacques Raynaud; Jean-Marc Sabate; Robert Benamouzig

doi:10.5056/jnm20094

J Neurogastroenterol Motil https://doi.org/10.5056/jnm20094

Lactose sensitivity and lactose malabsorption. The two faces of lactose intolerance

Michel Bouchoucha^{1, 2*}, Marinos Fysekidis³, Pierre Rompteaux², Jean-Jacques Raynaud², Jean-Marc Sabate², and Robert Benamouzig²

¹Department of Physiology, Université René Descartes, Paris V, Paris, France;
²Department of Gastroenterology, Avicenne Hospital, Bobigny, France; and
³Nutrition and Diabetology, Hôpital Jean Verdier, Bondy, France

Correspondence to: Michel Bouchoucha, MD, PhD
Service de gastro-entérologie, CEFRED (Centre d'Exploration Fonctionnelle et de Rééducation Digestive), Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny Cedex, France
Tel: +33-148-957-432, Fax: +33-148-957-437, E-mail: michel.bouchoucha@aphp.fr

Received: April 25, 2020; Revised: June 25, 2020; Accepted: August 3, 2020; Published online: December 28, 2020.

Abstract: Background/Aims
Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of FBD patients without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features.
Methods
One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose test in which glycemia during 60 minutes and digestive symptoms during 3 hours were recorded.
Results
Abnormal lactose tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea (P = 0.040) and a lower frequency of dysphagia (P = 0.031). LS patients had a higher depression score (P = 0.007), higher frequency of globus (P = 0.042), irritable bowel syndrome (IBS) (P = 0.027) and mixed IBS (P = 0.049), and lower frequency of abdominal pain (P = 0.040). LS was significantly associated with higher depression score (P = 0.002), and higher frequency of globus (P = 0.046).
Conclusions
Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.; Keywords: Diarrhea, Irritable bowel syndrome, Lactose intolerance