LACTOSE INTOLERANCEC2 GROUP 3PADILLA, KATHELENE ZENAS PADILLA, SHIELA PADULLO, MARK ISIDORE PAJARIT, ARIANNE PANDAAN, ALEXIS LEOVIC PANGA, RUTH ELIZABETH PAPANDAYAN, ZAINODIN PARAFINA, SIMONELLE

Specific ObjectivesAt the end of the conference, the students should be able to: Familiarize themselves with the food sources of lactose. Understand how the body normally digest and utilize lactose. Know the difference between lactose intolerance and lactase deficiency. Enumerate and discuss the three distinct clinical syndromes of lactase deficiency.

Enumerate and differentiate the different types of lactose intolerance. Characterize the clinical manifestations of lactose intolerance and correlate the molecular basis of each. Enumerate and discuss the laboratory tests/procedures used to diagnose lactose intolerance.

CASE REPORTA 54-year old woman from Cebu presented with complaints of abdominal distension and bloating after meals, with increased flatulence and episodic diarrhea of about 1 years duration. These symptoms occur 30 minutes to 4 hours after meals. She knows of no aggravating factors and feels best early in the morning before she eats. Fasting for 8 hours results in complete relief of all symptoms. She has had no nausea or vomiting. She described mild suprapubic cramping and urgency before bowel movements; this discomfort was promptly relieved by defecating.

There is no history of diabetes, previous gastrointestinal injury, foreign travel, skin rash, or previous radiation exposure. Her past history was significant for low back pain; she had sustained a pathological compression fracture of the lumbar spine 15 months ago. At that time, she had been diagnosed as having osteoporosis and was advised to increase her dietary calcium intake. She estimated her average milk consumption for the last 6 months for about 3 cups (24 oz.) per day. Her physical examination was normal and the stool was negative for occult blood. Flexible sigmoidoscopy was performed and was normal.

CASE REPORT: DiagnosisRESULTS HEMOGLOBIN HEMATOCRIT SERUM ALBUMIN SERUM CHOLESTEROL 15 g/dL 46% 4.5 g/ dL 210 mg/dL NORMAL RANGE 14-16 g/dL 44-50% 3.8-4.8 g/dL 20 ppm above the zerotime level supports the diagnosis of lactase deficiency its results cannot be extrapolated to indicate that a patient will necessary be symptomatic if lesser or more physiologic quantities of lactose.

2.

ORAL LACTOSE TOLERANCE TEST Measure serial blood glucose levels after an oral lactose load. A fasting serum glucose level is obtained, after which 50 g of lactose is administered. Measure the serum glucose level at 0, 60, and 120 minutes. The lactose tolerance test has a sensitivity of 75% and a specificity of 96%. HYPOLACTASIA: rise in blood glucose of 1.7 mmol/L (30 mg/dL)

3.

LACTOSE-ETHANOL LOAD TEST measure blood galactose and is a more specific test for lactase activity. Hypolactasia is indicated by a blood galactose level of less than 0.3 mmol/dL

4.

QUANTITATION OF SMALL BOWEL LACTASE ACTIVITY performed on tissue sample obtained from distal duodenum by endoscopy or jejunal biopsy. most accurate useful for research purposes, but seldomly used clinically.

TreatmentMedical Care Dietary adjustment is the primary form of therapy for patients with lactose intolerance.Advise patients to reduce or restrict products containing lactose. Yogurt and fermented products, such as cheeses, are better tolerated than regular milk. Soy-based milk or food products are well tolerated.

Lactase enzyme preparations (eg, LACTAID, Lactrase) reducing symptoms Supplemental calcium In secondary lactase deficiency, treatment is directed at the underlying cause.

Complications Complications of lactose intolerance may include osteopenia. Prognosis Excellent with dietary restrictions.

Patient Education Instruct patients to read labels on commercial products. Whole milk and chocolate milk may be better tolerated than skim milk.