A study on the outcome of lactose hydrogen breath test (LHBT) in children: is it a useful tool?
Abstract
Objectives: Approximately 70% of the world's population has hypolactasia, which often remains undiagnosed and has the potential to cause morbidity. Children with lactose malabsorption can present with chronic diarrhoea, increased flatulence, abdominal pain or constipation. The simple solution is a trial of lactose free diet(LFD). But this could have detrimental effects on a growing child. To assess the usefulness of LHBT as an objective measure of lactose intolerance (LI) and to assess whether unnecessary dietary restriction can be reduced using this test.
Method: We retrospectively reviewed 36 patients with symptoms of lactose intolerance, who underwent LHBT, attending the Paediatric Gastroenterology Clinic at Russells Hall Hospital from 2009-2011.
Results: 36 children(20M:16F), (34 caucasian:2 asian) aged 3-17 years were identified. The presenting symptoms were chronic diarrhoea(12), flatulence(14), constipation(12), abdominal pain(10) and alternating diarrhoea and constipation(2). 12/36(33%) patients were LHBT positive (peak breath hydrogen levels>20ppm). In 8/12 hydrogen load suggested LI and in 4/12 small bowel bacterial overgrowth (SBBO). 5/8 with positive LI, showed marked improvement on a LFD. Although 24/36 were negative LHBT, 5/24 patients were commenced on a trial of LHBT, with 3/5 demonstrating resolution of symptoms.
Conclusion: LHBT is a simple, non invasive and cost effective test that is useful in diagnosing LI in children. It gives objective evidence to parents to commence on a LFD, thereby avoiding unnecessary omission of milk and dairy-products (23/36 potential cases in our study) that can have detrimental effects on calcium and vitamin D intake in children.
