Summary
Definition
History and exam
Key diagnostic factors
- black, Native American, Asian, or Hispanic ethnicity
- adolescence and early adulthood
- family history of lactase deficiency
- enteritis/gastroenteritis
- comorbid predisposing disease
- history of irritable bowel syndrome diagnosis
- symptoms after ingestion of dairy products
- diarrhea
- distention
- lethargy
- mouth ulceration
- headache
- poor short-term memory
- poor concentration
- muscle/joint pain
- eczema
- failure to thrive
Other diagnostic factors
- abdominal pain/discomfort
- borborygmi
- flatulence
- skin rashes
- palpitations
- history of asthma
- history of peptic ulcer disease
- history of gastroesophageal reflux disorder
- nausea
- vomiting
- constipation
- pallor
- steatorrhea
- weight loss
- short stature
- progressive disability
- flushing
- sensory loss
- edema
- hair loss
Risk factors
- black, Native American, Asian, or Hispanic ethnicity
- adolescence and early adulthood
- family history of lactase deficiency
- enteritis/gastroenteritis
- comorbid predisposing disease
- history of irritable bowel syndrome diagnosis
Diagnostic investigations
Investigations to consider
- lactose hydrogen breath test
- stool culture
- fecal pH
- fecal reducing substance/sugar
- lactose tolerance test
- small bowel biopsy
Treatment algorithm
Contributors
Authors
Dr Anton Emmanuel, MD, FRCP
Academic Neuro-Gastroenterologist
University College London
Consultant Gastroenterologist
University College Hospital and the National Hospital for Neurology and Neurosurgery (Queen Square)
London
UK
Disclosures
AE declares that he has no competing interests.
Acknowledgements
Dr Anton Emmanuel would like to gratefully acknowledge Dr Mohammad Azam and Dr Richard J. Farrell, previous contributors to this monograph. MA and RJF declare that they have no competing interests.
Peer reviewers
Anthony Lembo, MD
Assistant Professor of Medicine
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
AL declares that he has no competing interests.
Michele Di Stefano, MD
Coordinator of the Gastrointestinal Motility Laboratory
University of Pavia
1st Division of Medicine
IRCCS S. Matteo Hospital Foundation
Pavia
Italy
Disclosures
MDS is the author of references cited in this topic.
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