MALABSORPTION AND LACTOSE INTOLERANCE: PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF PATHOGENESIS

  • Olena Sharikadze д.м.н., доцент, кафедра педіатрії №1, Національний Університет Охорони Здоров’я України імені П.Л. Шупика, Україна
Keywords: food intolerance; lactose intolerance; lactose malabsorption; lactose maldigestion; Alactase

Abstract

The problem of lactose metabolism remains relevant from the standpoint of various areas of medical research. Clinicians, anthropologists, physiologists and geneticists are engaged in the study of lactose digestion devices and various types of disorders associated with it, including lactose intolerance.
Determination of such mechanisms allows us to understand not only the nutritional causes of the development of functional intestinal symptoms, but also the evolution of man and nutrition, culture and lifestyle. Symptoms of lactose intolerance are abdominal pain, flatulence, nausea, bloating, and diarrhea after drinking milk or dairy products. These symptoms may be caused by malabsorption of lactose, which is the result of low levels of lactase in the small intestine. Symptoms also occur after consumption of lactose or lactose products, with no apparent effect on the human microbiota and overall health. Therefore, of particular concern are the strict dairy-free diets commonly prescribed for patients with such complaints.
This article discusses modern recommendations for the diagnosis and treatment of lactose malabsorption and lactose intolerance, which largely comply with European recommendations.

References

Misselwitz B, Butter M, Verbeke K, et alUpdate on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical managementGut 2019;68:2080-2091.

Bayless TM, Brown E, Paige DM. Lactase non-persistence and lactose intolerance. Curr Gastroenterol Rep 2017;19:23.

Silanikove N, Leitner G, Merin U. The Interrelationships between lactose intolerance and the modern dairy industry: global perspectives in evolutional and historical backgrounds. Nutrients 2015;7:7312–31.

Reich CM, Arnould JPY. Evolution of Pinnipedia lactation strategies: a potential role for α-lactalbumin? Biol Lett 2007;3:546–9.

Slupsky CM, He X, Hernell O, et al. Postprandial metabolic response of breast-fed infants and infants fed lactose-free vs regular infant formula: A randomized controlled trial. Sci Rep 2017;7:3640.

Grenov B, Briend A, Sangild PT, et al. Undernourished children and milk lactose. Food Nutr Bull 2016;37:85–99

Zecca L., Mesonero J.E., Stutz A., Poir e J.C., Giudicelli J., Cursio R.et al. Intestinal lactase-phlorizin hydrolase (LPH): the two catalytic sites; the role of the pancreas in pro-LPH maturation. FEBSL ett. 1998;

; 435(2- 3):225-8.doi: 10.1016/S0014-5793(98)01076-X

Enattah N, Pekkarinen T, Välimäki MJ, et al. Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in Finnish postmenopausal women. Eur J Clin Nutr 2005;59:1105–11.

Misselwitz B, Fox M. What is normal and abnormal in lactose digestion? Lancet Gastroenterol Hepatol 2017;2:696–7.

Zhao J, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010;31:892–900.

А.Е. Абатуров, А.А. Никулина, Л.Л. Петренко Лактазная недостаточность у детей. Международный журнал педиатрии, акушерства и гинекологии.2015.- Том 7 (2). -С.51-63.

Sundquist J., Sundquist K. Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden. Br. J. Cancer 2014 Okt; 14:544.

Mattar R., Mazo D.F. Intoler ncia lactose: mudan a de paradigmas coma biologia molecular. Rev. Assoc. Med. Bras. 2010 Mar-Apr; 56(2):230-236.doi.org/10.1590/S0104-42302010000200025

Burger J., Kirchner M., Bramanti B., Haak W., Thomas M.G. The lactase-persistence-associated allele in early Neolithic Europeans. Proc. Natl. Acad. Sci. USA.2007; 104: 3736–3741

Brannon PM, Carpenter TO, Fernandez JR. еt al. NIH consensus development conference statement: lactose intolerance and health. NIH Consens State Sci Statements 2010; 2(2):1–27.

Dzialanski Z, Barany M, Engfeldt P, et al. Lactase persistence versus lactose intolerance: Is there an intermediate phenotype? Clin Biochem 2016;49:248–52/

Davidson GP, Goodwin D, Robb TA. Incidence and duration of lactose malabsorption in children hospitalized with acute enteritis: Study in a well-nourished urbanpopulation. J Pediatr 1984;105:587–90.

Hu Y, Gui L, Chang J, et al. The incidence of infants with rotavirus enteritis combined with lactose intolerance. Pak J Pharm Sci 2016;29(1 Suppl):321–3.

Bonani M, Pereira RM, Misselwitz B, et al. Chronic norovirus infection as a risk factor for secondary lactose maldigestion in renal transplant recipients: a prospective parallel cohort pilot study. Transplantation 2017;101:1455–60.

Wilder-Smith CH, Olesen SS, Materna A, et al. Fermentable sugar ingestion, gas production, and gastrointestinal and central nervous system symptoms in patients with functional disorders. Gastroenterology 2018;155:1034–44.

Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017;2:738–46.

Deng Y, Misselwitz B, Dai N, et al. Lactose intolerance in adults: biological mechanism and dietary management. Nutrients 2015;7:8020–35.

Misselwitz B, Pohl D, Frühauf H, et al. Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterol J 2013;1:151–9.

Obermayer-Pietsch B.M., Bonelli C.M., Walter D.E., Kuhn R.J., Fahrleitner-Pammer A., Berghold A. et al. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res. 2004 Jan; 19(1):42-47

Eadala P., Matthews S.B., Waud J.P., Green J.T., Campbell A.K. Association of lactose sensitivity with inflammatory bowel disease – demonstrated by analysis of genetic polymorphism, breath gases and symptoms. Aliment. Pharmacol. Ther. 2011; 34: 735–746.

Von Tirpitz C., Kohn C., Steinkamp M., Geerling I., Maier V., M ller P., Adler G., Reinshagen M. Lactose intolerance in active Crohn's disease: clinical value of duodenal lactase analysis. J. Clin. Gastroenterol. 2002; 34:49-53

Basso M.S., Luciano R., Ferretti F., Muraca M., Panetta F., Bracci F.еt al. Association between celiac disease and primary lactase deficiency. European Journal of Clinical Nutrition. – 2012; 66: 1364 – 1365

Корниенко Е.А., Минина С.Н., Фадина С.А., Лобода Т.Б. Клиника, диагностика и лечение лямблиоза у детей. Педиатрическая фармакология. 2009;6: 40-47.

Делягин В.М., Каграманова К.Г., Шугурина Е.Г., Сичинава И.В., Соколова М.В., Боринская С.А. и др. Полиморфизм гена лактазы у детей с атопическими заболеваниями. Педиатрия 2008; 87(4):16-24.

Gaffey MF, Wazny K, Bassani DG, et al. Dietary management of childhood diarrhea in low- and middleincome countries: a systematic review. BMC Public Health 2013;13(Suppl 3):S17.

Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr 1996;64:232–6

Szilagyi A, Shrier I, Heilpern D, et al. Differential impact of lactose/lactase phenotype on colonic microflora. Can J Gastroenterol 2010;24:373–9.

Mäkivuokko HA, Saarinen MT, Ouwehand AC, et al. Effects of lactose on colon microbial community structure and function in a four-stage semi-continuous culture system. Biosci Biotechnol Biochem 2006;70:2056–63.

Tan J, McKenzie C, Potamitis M, et al. The role of short-chain fatty acids in health and disease. Adv Immunol 2014;121:91–119.

Canfora EE, Jocken JW, Blaak EE. Short-chain fatty acids in control of body weight and insulin sensitivity. Nat Rev Endocrinol 2015;11:577–91.

Gonçalves P, Martel F. Butyrate and colorectal cancer: the role of butyrate transport. Curr Drug Metab 2013;14:994–1008.

Dalile B, Van Oudenhove L, Vervliet B, et al. The role of short-chain fatty acids in microbiota-gut-brain communication. Nat Rev Gastroenterol Hepatol 2019;12.

Lukito W, Malik SG, Surono IS, et al. From ’lactose intolerance’ to ’lactose nutrition’. Asia Pac J Clin Nutr 2015;24(Suppl 1):S1–8.

Casellas F, Aparici A, Pérez MJ, et al. Perception of lactose intolerance impairs healthrelated quality of life. Eur J Clin Nutr 2016;70:1068–72.

Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015;27:1138–46.

Böhn L, Störsrud S, Simrén M. Nutrient intake in patients with irritable bowel syndrome compared with the general population. Neurogastroenterol Motil 2013;25:23–e1.

Hay P, Mitchison D, Collado AEL, et al. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord 2017;5:21.

Hammer HF, Hammer J, Fox M. Mistakes in the management of carbohydrate intolerance and how to avoid them. UEG Education 2019;19:9–14.

Shaukat A, Levitt MD, Taylor BC, et al. Systematic review: effective management strategies for lactose intolerance. Ann Intern Med 2010;152:797–803.

Deng Y, Misselwitz B, Dai N, et al. Lactose intolerance in adults: biological mechanism and dietary management. Nutrients 2015;7:8020–35

Savaiano DA, Ritter AJ, Klaenhammer TR, et al. Improving lactose digestion and symptoms of lactose intolerance with a novel galacto-oligosaccharide (RP-G28): a randomized, double-blind clinical trial. Nutr J 2013;12:160.

Ianiro G, Pecere S, Giorgio V, et al. Digestive enzyme supplementation in gastrointestinal diseases. Curr Drug Metab 2016;17:187–93.

Ibba I, Gilli A, Boi MF, et al. Effects of exogenous lactase administration on hydrogen breath excretion and intestinal symptoms in patients presenting lactose malabsorption and intolerance. Biomed Res Int 2014;2014:1–7.

Oak SJ, Jha R. The effects of probiotics in lactose intolerance: a systematic review. Crit Rev Food Sci Nutr 2019;59.

Goodrich JK, Davenport ER, Clark AG, et al. The relationship between the human genome and microbiome comes into view. Annu Rev Genet 2017;51:413–33.

Bonder MJ, Kurilshikov A, Tigchelaar EF, et al. The effect of host genetics on the gut microbiome. Nat Genet 2016;48:1407–12.

Views:

265

Downloads:

171

Published
2022-04-12
Citations
How to Cite
Olena Sharikadze. (2022). MALABSORPTION AND LACTOSE INTOLERANCE: PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF PATHOGENESIS. World Science, (3(75). https://doi.org/10.31435/rsglobal_ws/30042022/7804
Section
Medicine