​Kembara Xtra - Medicine - Lactose Intolerance

​Kembara Xtra - Medicine - Lactose Intolerance 
A condition known as lactose intolerance causes bloating, gas, and abdominal pain after consuming lactose.
Lactose malabsorption is caused by a decrease in lactase activity in the small intestinal mucosa's brush border.
The lactase activity reaches its maximum at birth and subsequently declines over the course of the first few months of life. In 75% of adults around the world, lactase activity decreases after birth. To digest lactose without triggering lactose intolerance symptoms, just 50% of lactase activity is required.
Congenital lactose intolerance is extremely uncommon.
Secondary lactose intolerance is the inability to digest lactose brought on by any condition that damages the intestinal mucosa (for example, infectious enteritis, celiac disease, eosinophilic gastroenteritis, or inflammatory bowel disease) or reduces the amount of mucosal surface that is available (for instance, resection). Primary lactose intolerance is common in adults who develop low lactase levels after childhood.
Lactose malabsorption can be asymptomatic and affects people with functional bowel problems and healthy people equally.
Endocrine/metabolic, gastrointestinal system(s) affected
Child Safety Considerations
Late infancy is when primary lactose intolerance first manifests.
There is disagreement over whether lactose should be avoided in young children (under the age of 5) who have diarrheal sickness.
There are formulae that don't contain lactose.
 Rule out a milk protein sensitivity.

Epidemiology Incidence
50% of newborns with acute or chronic diarrheal illness and rotavirus infection have lactose intolerance.
Giardiasis, ascariasis, irritable bowel syndrome (IBS), tropical and nontropical sprue, and AIDS malabsorptive syndrome are all conditions that are frequently accompanied by lactose intolerance.

Prevalence

 More than 50% of people in South America, Africa, and Asia are lactose intolerant.
In America, the frequency is 15% for white people, 53% for Hispanic people, and 80% for African Americans. In Europe, lactose intolerance ranges from 15% in Scandinavia to 70% in Italy. The two main age groups are adolescents and adults.
Depends on the underlying disease, secondary
Male = female is the dominant sex.

Pathophysiology and Etiology 
Primary lactose intolerance: After weaning from breast milk, the normal reduction in lactase activity in the intestinal mucosa is genetically defined and irreversible.
In addition to being linked to gastroenteritis in children, secondary lactose intolerance is also linked to any intestinal inflammation or infection that causes lactose malabsorption in both adults and children.

Genetics: In white people, a single nucleotide polymorphism (SNP) characterized by a T for C nucleotide substitution at position 13910 on chromosome 2 is linked to lactase insufficiency. CC-13910 (lactase nonpersistence) or CT-13910/TT-13910 (lactase persistence) variations are the outcome of this.
In northern Europeans, the SNP (C/T-13910) is linked to lactase persistence.
 In some patients of African heritage, other SNPs (G/C-14010, T/G-13915, and C/G-13907) have been associated with lactase persistence.


Risk Elements 

Geographic variation in adult-onset lactase insufficiency is significant.
Age: Typically, signs and symptoms do not appear until a child reaches the age of 6 to 7 years.
– Depending on the amount of dietary lactose consumed and the rate at which intestinal lactase activity declines, symptoms may not become apparent until maturity.

Prevention 

Symptoms are reduced by avoiding lactose. Patients can find out how much lactose is allowed in their diet.

IBS or other functional bowel diseases, tropical or nontropical sprue, giardiasis, small intestine bacterial overgrowth (SIBO), celiac disease

Diagnosis It is possible to assume that a patient has lactose intolerance if they experience minor symptoms after consuming considerable amounts of the sugar (such as more than two servings of dairy per day), and if their symptoms go away after avoiding lactose-containing meals for a week.
Lactose intolerance can resemble the symptoms of functional gastrointestinal diseases, and a positive lactose hydrogen breath test is confirmatory. Additionally, lactose intolerance is a disorder that can coexist.

Analyze the historical lactose intake.
When lactose intolerance sufferers take 12 g of lactose (12 g is equal to 1 cup of milk), they may have just minimal symptoms.
With other nutrients, doses of 15 to 18 g of lactose are well tolerated. More symptoms are caused by doses greater than 18 g, and the majority of people have problems at doses greater than 50 g.
30 to 2 hours after consuming lactose-containing items, symptoms start to appear.
Bloating, gas, cramping stomach pain, diarrhea, and/or loose stools are among the symptoms.
Adolescents may report vomiting.
 Lower quadrants or the periumbilical region are frequent sites of localized abdominal pain that might be crampy in nature.
Stools are often large, foamy, and liquid, while adults may occasionally experience diarrhea.
Only 20–30% of those who have lactose malabsorption experience symptoms.

clinical assessment 

Audible bowel noises (borborygmi) on physical examination (may be particularly uncomfortable to the patient) are normally normal, as are vital signs and overall look. Other than that, the exam is usually non-specific or normal.

Differential diagnosis: functional gastrointestinal condition (like IBS), SIBO, celiac disease, inflammatory bowel disease, giardiasis, drug- or radiation-induced enteritis, sucrase deficiency, and allergy to cow's milk protein

Initial test results from the laboratory and imaging
As a confirmatory test for lactose intolerance, the lactose breath test (LBT) is used. It is simple to execute and non-invasive (78% sensitivity, 98% specificity).
 When you exhale, intestinal bacteria break down carbohydrates and create detectable amounts of hydrogen and methane:
– Give lactose when fasting (2 g/kg; maximum dose in children is 25 g; in adults, it's 50 g). Keep track of any symptoms and take breath hydrogen samples at baseline and every 30 minutes for three hours. Compare the baseline and postlactose levels. Lactose malabsorption can be diagnosed by a 20 ppm increase in hydrogen concentration over baseline. SIBO is suggested by an early peak (15 to 30 minutes).
 Rarely necessary small bowel biopsy for histopathology and direct assessment of lactase activity
Lactose malabsorption is confirmed by a positive LBT, but the cause is not identified.

Diagnostic Techniques/Other The lactose tolerance test, an alternative to the lactose breath test (LBT) for adults, assesses lactose absorption using measurements of serum glucose. Blood glucose levels are checked at 0, 60, and 120 minutes after oral administration of a 50-g test dosage in adults (2 g/kg in children). Diagnostic is an increase in blood glucose of 20 mg/dL (1.1 mmol/L) together with the onset of symptoms.
Patients with hyperglycemia or bacterial overgrowth may experience false-negative results.
If stool electrolyte testing is carried out, it may reveal an osmotic gap in the stool greater than 125 mOsm/kg, albeit this is not a sign of lactose intolerance.
Interpretation of Tests
By performing a small bowel biopsy, low lactase enzyme activity in the intestinal mucosa can be patchy or localized.

Management 

There is inadequate data to advocate any specific therapy as the first line of treatment, including probiotics, colonic adaptation, and other dietary supplements.
When there is no treatable underlying disease, there are four main concepts for treatment.
- To alleviate symptoms, avoid milk and dairy products.
- One cup of milk can contain up to 12 to 15 g of lactose without causing any noticeable symptoms.
- Reintroduce lactose gradually as your symptoms permit.
Tolerance is increased by distributing lactose portions throughout the day.
– Lactose should be replaced with fermented and matured milk products if symptoms continue.
Certain probiotic strains, dosages, and formulations may reduce symptoms.
The effectiveness of gradually increasing lactose dosages to promote adaption is limited.
Lactose-reduced or hydrolyzed milk, lactase supplements given with milk, or probiotics are not commonly advised due to a lack of evidence.
 Continue consuming calcium and vitamin D.


First Line of Medicine

Commercially accessible "lactase" preparations are yeast or bacterial -galactosidases, sometimes known as lactase (Lactaid, Lactrase).
Take 1 to 2 tablets or capsules before consuming dairy products.
Variable levels of success in symptom prevention.
 Before consuming, you can add tablets or capsule contents to milk (1 to 2 caps/tabs per quart of milk); in certain places, milk is also sold commercially with these additives.
 Ineffective for all lactose intolerant individuals

Healthcare Alternatives 
Certain probiotic preparations taken with meals may reduce some lactose intolerance symptoms.


Constant Care 

Reduce or limit your intake of lactose to manage your symptoms—this involves some patient-specific "trial and error."
 Yogurt and other fermented foods, such hard cheese, are frequently more tolerable than milk.
 Take calcium supplements, such as calcium carbonate.
 Lactaid, which is prehydrolyzed milk, is offered.

Patient Education Read the labels on commercial products; many of them include milk sugar, which might lead to symptoms.
Lactose is better tolerated when ingested with other foods rather than when consumed with milk alone. Patients may handle whole milk or chocolate milk better than skim milk (slower rate of stomach emptying).
Secondary lactose intolerance is often transient, though it might linger for months after the triggering event. Primary lactase deficiency is permanent.
20% of prescription medications and 6% of OTC medications may use lactose as a basis.
The majority of people who suffer from lactose intolerance or malabsorption may consume 12 to 15 g of lactose per day.

Normal life expectancy; if lactase medications are ineffective, symptoms can be managed only by food.

Complications 

Calcium deficiency: Reducing your diet of milk and other dairy products can raise your risk of osteoporosis and fractures.