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• W1992165718 abstract "More than 40 years ago, the hydrogen breath test (H2 BT) was proposed as a simple test to diagnose lactose malabsorption and some methodological aspects are still debated. One important point is carbohydrate load: while a 50 g dose, the amount of lactose in 1 l of milk, seems excessive, there is agreement that a 20–25 g dose, or even less [ [1] Suarez F.L. Savaiano D. Arbisi P. Levitt M.D. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr. 1997; 65: 1502-1506 PubMed Scopus (138) Google Scholar ], is a more physiological load. Nevertheless, in commenting on our results, Schirru et al. raise an objection diametrically opposite this trend: an increased load induces a better agreement between H2 BT and the genetic test. However, an even more important aspect is solution concentration and the induction of an osmotic effect and accelerated transit. Our group previously showed that administration of several sorbitol solutions at increasing concentrations is accompanied by a parallel increased prevalence of malabsorption [ [2] Corazza G.R. Strocchi A. Rossi R. Sirola D. Gasbarrini G. Sorbitol malabsorption in normal volunteers and in patients with coeliac disease. Gut. 1988; 29: 44-48 Crossref PubMed Scopus (68) Google Scholar ]: 5 g of sorbitol in 250 ml of water (2% solution) reveals malabsorption in 10% of healthy volunteers; doubling the concentration to 4%, (10 g/250 ml) resulted in 90% of positive tests in the same group of volunteers. Furthermore, an 8% solution induced 100% of positive tests. Finally, the administration of 50 g of lactose in 100 or 150 ml of water, thus a 50% or a 34% solution, respectively, might be responsible for an expected positive result, due to the high osmotic effect. The dose of 25 g is considered “more physiological”, as Schirru et al. also stated: this should induce to perform a more in-depth critical analysis of the results obtained with a non-physiological dose (50 g) of carbohydrate. We believe that the increase of carbohydrate load and concentration result in a significant modification of specificity, and false-positivity may explain the better agreement between a 50 g lactose breath test and the genetic test." @default.
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• W1992165718 date "2009-09-01" @default.
• W1992165718 modified "2023-09-24" @default.
• W1992165718 title "Author's Reply to Lactose malabsorption: Hydrogen breath test versus genetic testing" @default.
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• W1992165718 doi "https://doi.org/10.1016/j.dld.2009.03.006" @default.
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