Lactose malabsorption based on breath hydrogen test in children with recurrent abdominal pain
Keywords:
lactose malabsorption, recurrent abdominal pain, breath hydrogen test, schoolage children
Abstract
Background Recurrent abdominal pain (RAP) is common amongschool-age children. Previous studies found that lactose malab-
sorption has an important role in RAP in children. Up to date, data
on the prevalence of lactose malabsorption in children with RAP
in Indonesia has not been available.
Objective To elicit the prevalence of RAP and lactose malabsorption in
children with RAP, and to determine associated foods that cause RAP
in children with and without lactose malabsorption, the frequency of
lactose intolerance during breath hydrogen test (BHT), and also the
onset and duration of the symptoms after a lactose load.
Methods This was a cross-sectional study conducted on junior
high school students who suffered from recurrent abdominal pain.
Results Of 1054 students screened, 157 (14.9%) fulfilled the Apley’s
criteria for RAP. Of 157, 85 children were enrolled and underwent
BHT. Fifty five of them (65%) were girls. Lactose malabsorption
was found in 68 (80%) subjects. Milk and yogurt were the most
frequent products that cause symptoms of RAP in our subjects
who mostly (80%) were malabsorber. Lactose intolerance during
BHT was found in 69 (81%) children. Symptoms appeared in 30
minutes after lactose ingestion, and the most frequent symptom
was abdominal pain (44%). Lactose intolerance symptoms disap-
peared in about 15 hours.
Conclusions The prevalence of RAP in children aged 12-14 years
was 14.9%. The prevalence of lactose malabsorption in children
with RAP was 80%. Milk and yogurt were the most frequent products
that cause symptoms of RAP in our subjects who mostly were
malabsorbers. The frequency of lactose intolerance during BHT
was 81%, and the symptoms lasted within approximately 15 hours
References
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Gastroenterol Nutr 1995;7:529-32.
2. Hyam JS, Treem WR, Justinich CJ, Davis P, Shoup M,
Burke G. Characterization of symptoms in children with
recurrent abdominal pain: resemblance to irritable bowel
syndrome. J Pediatr Gastroenterol Nutr 1995;20:209-14.
3. Gremse DA, Nguyenduc GH, Sacks Al, Di Palma JA.
Irritable bowel syndrome and lactose maldigestion in
recurrent abdominal pain in childhood. Southern Med
J 1999;92:778-81.
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maldisgestion and recurrent abdominal pain in
children. Dig Dis Sci 1995;7:1506-10.
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and lactose malabsorption in school-age children.
Gastroenterol Nutr 1997;20:180-3.
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Hyams JS, editors. Pediatric gastrointestinal disease:
pathophysiology, diagnosis, management. Philadelphia:
W.B. Saunders Co; 1993. p. 177-86.
7. Walker LS, Guite JW, Duke M, Barnard JA, Greene
JW. Recurrent abdominal pain: a potential precursor of
irritable bowel syndrome in adolescents and young
adults. J Pediatr 1998;132:1010-5.
8. Firmansyah A. Aspek diagnostik sakit perut berulang.
Maj Kedok Indones 1991;9:525-8.
9. Wald A, Chandra R, Fisher SE, Gartner JC, Zitelli B.
Lactose malabsorption in recurrent abdominal pain of
childhood. J Pediatr 1982;100:65-8.
10. Buller HA. Recurrent abdominal pain in children.
Expert lecture. Presented at Pediatric Departement
Medical School, University of Indonesia; 2000 Apr 14;
Jakarta, Indonesia.
11. Boediarso A. Perkembangan laktase dan hubungannya
dengan makanan bayi. Sari Pediatri 1993;1:17-20.
12. Lebenthal E, Kretchmer N, Alliet P. Lactase deficiency,
lactose malabsorption, and lactose intolerance. In:
Lebenthal E, editor. Textbook of gastroenterology and
nutrition in infancy. 2nd ed. New York: Raven Press;
1989. p. 459-72.
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laboratorium. Maj Kes Masy Indones 1996;5:318-21
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literature [dissertation]. Netherland: University of
Amsterdams; 1990.
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prospective study. N Engl J Med 1979;300:1449-52.
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lactose and sucrose intolerance, a prospective study.
Pediatrics 1979;64:43-5.
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children with recurrent abdominal pain. Pediatrics
1980;65 :681-2.
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Recurrent abdominal pain and lactose absorption in chil-
dren. Pediatrics 1981;67:828-32.
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abdominal pain and lactose intolerance in childhood.
Br Med J 1981;282:2013-4
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N, et al. Lactose malabsorption and recurrent abdominal
pain in Italian children. J Pediatr Gastroenterol Nutr
1988;7:852-7.
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and lactose malabsorption in childhood [abstract]. Orv
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wahec/ful232.htm-26k.
23. Suharjono, Sunoto, Boediarso A, Sutedjo. Lactose mal-
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Indones 1971;11:251-4.
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intolerance in Indonesian children. Paediatr Indones
1973;13:241-9.
25. Hegar B, Firmansyah A, Boediarso A, Sunoto. Aktivitas
enzim laktase pada murid taman kanak-kanak. Maj
Kedok Indones 1997;2:125-7.
26. Hegar B, Niken PY, Sayoeti Y, Dwipurwantoro PG,
Firmansyah A. Aktivitas enzim laktase pada murid
sekolah dasar. Maj Kedok Indones 2001;51:154-6
27. Sofia D. Prevalens malabsorpsi laktosa murid SLTP
Negeri 7 Jakarta [thesis]. Jakarta: Department of Child
Health, Medical School, Univ. of Indonesia; 2002.
28. Apley. The child with abdominal pain. London: Blackwell
Scientific Publ; 1975. p. 3-54.
29. Walker WA, Hendricks KM. Pediatric Nutrition.
Philadelphia: WB Saunders; 1985.
30. Boediarso A. Sakit perut berulang. Proceedings of
the National Symposium of Badan Koordinasi
Gastroenterologi Anak Indonesia. In: Munyi R,
Abimanyu, Sofyan I, editors. Banjarmasin; 2000. p.
59-70
31. Van der Meer SB. Chronic recurrent abdominal pain in
school children [abstract].Tidjschr Kindergeneeskd
1993;61:69-75.
32. Thiessen PN. Recurrent abdominal pain. Pediatrics in
review 2002;23:39-46
33. Rings EHHM, Grand RJ, Buller HA. Lactose intoler-
ance and lactase deficiency in children. Pediatrics
1994;6:562-7.
34. Buller HA, Grand RJ. Lactose intolerance. Annu Rev
Med 1990;41:141-8.
35. American academy of pediatrics - committee on nutri-
tion. The practical significance of lactose intolerance
in children. Pediatrics 1978;62:240-5.
36. Buller HA, Rings EHHM, Montgomery RK, Grand
RJ. Clinical aspect of lactose intolerance in children
and adults. Scand J Gastroenterol 1991;26:73-80.
37. Montes RG, Perman JA. Lactose intolerance. Postgrad
Med 1991;89:175-84.
38. Hegar B, Buller HA. Breath hydrogen test in lactose
malabsorption. Paediatr Indones 1995;35:161-71
Gastroenterol Nutr 1995;7:529-32.
2. Hyam JS, Treem WR, Justinich CJ, Davis P, Shoup M,
Burke G. Characterization of symptoms in children with
recurrent abdominal pain: resemblance to irritable bowel
syndrome. J Pediatr Gastroenterol Nutr 1995;20:209-14.
3. Gremse DA, Nguyenduc GH, Sacks Al, Di Palma JA.
Irritable bowel syndrome and lactose maldigestion in
recurrent abdominal pain in childhood. Southern Med
J 1999;92:778-81.
4. Webster RB, DiPalma JA, Gremse DA. Lactose
maldisgestion and recurrent abdominal pain in
children. Dig Dis Sci 1995;7:1506-10.
5. Di Palma AN, Di Palma JA. Recurrent abdominal pain
and lactose malabsorption in school-age children.
Gastroenterol Nutr 1997;20:180-3.
6. Mews CF, Sinatra FR. Abdominal pain. In: Wyllie R,
Hyams JS, editors. Pediatric gastrointestinal disease:
pathophysiology, diagnosis, management. Philadelphia:
W.B. Saunders Co; 1993. p. 177-86.
7. Walker LS, Guite JW, Duke M, Barnard JA, Greene
JW. Recurrent abdominal pain: a potential precursor of
irritable bowel syndrome in adolescents and young
adults. J Pediatr 1998;132:1010-5.
8. Firmansyah A. Aspek diagnostik sakit perut berulang.
Maj Kedok Indones 1991;9:525-8.
9. Wald A, Chandra R, Fisher SE, Gartner JC, Zitelli B.
Lactose malabsorption in recurrent abdominal pain of
childhood. J Pediatr 1982;100:65-8.
10. Buller HA. Recurrent abdominal pain in children.
Expert lecture. Presented at Pediatric Departement
Medical School, University of Indonesia; 2000 Apr 14;
Jakarta, Indonesia.
11. Boediarso A. Perkembangan laktase dan hubungannya
dengan makanan bayi. Sari Pediatri 1993;1:17-20.
12. Lebenthal E, Kretchmer N, Alliet P. Lactase deficiency,
lactose malabsorption, and lactose intolerance. In:
Lebenthal E, editor. Textbook of gastroenterology and
nutrition in infancy. 2nd ed. New York: Raven Press;
1989. p. 459-72.
13. Firmansyah A. Laktosa dan laktase, aspek biokimiawi dan
laboratorium. Maj Kes Masy Indones 1996;5:318-21
14. Buller HA. Lactase phlorizin hydrolase: a review of the
literature [dissertation]. Netherland: University of
Amsterdams; 1990.
15. Barr RG, Levine MD, Watkins JB. Recurrent abdominal
pain of childhood due to lactose intolerance: a
prospective study. N Engl J Med 1979;300:1449-52.
16. Liebman WM. Recurrent abdominal pain in children:
lactose and sucrose intolerance, a prospective study.
Pediatrics 1979;64:43-5.
17. Christensen MF. Prevalence of lactose intolerance in
children with recurrent abdominal pain. Pediatrics
1980;65 :681-2.
18. Lebenthal E, Rossi TM, Nord KS, Nord KS, Branski D.
Recurrent abdominal pain and lactose absorption in chil-
dren. Pediatrics 1981;67:828-32.
19. Blumenthal I, Kelleher J, Littlewood JM. Recurrent
abdominal pain and lactose intolerance in childhood.
Br Med J 1981;282:2013-4
20. Ceriani R, Zuccato E, Fontana M, Zuin G, Ferrari L, Principi
N, et al. Lactose malabsorption and recurrent abdominal
pain in Italian children. J Pediatr Gastroenterol Nutr
1988;7:852-7.
21. Hovarth K, Horn G, Hassan BG, Szamosi T, Nemes
NA, Bodanszky H. Chronic recurrent abdominal pain
and lactose malabsorption in childhood [abstract]. Orv
Hetil 1990;131:2631-5.
22. Quak SH, Wong CK. Recurrent abdominal pain: an
aetiological study among Singaporean children [cited
2004 Feb 5]. Available from URL: http://www.jicef.or.jp/
wahec/ful232.htm-26k.
23. Suharjono, Sunoto, Boediarso A, Sutedjo. Lactose mal-
absorption in healthy Indonesian children. Paediatr
Indones 1971;11:251-4.
24. Sunoto, Suharjono, Sutedjo. Two years study on sugar
intolerance in Indonesian children. Paediatr Indones
1973;13:241-9.
25. Hegar B, Firmansyah A, Boediarso A, Sunoto. Aktivitas
enzim laktase pada murid taman kanak-kanak. Maj
Kedok Indones 1997;2:125-7.
26. Hegar B, Niken PY, Sayoeti Y, Dwipurwantoro PG,
Firmansyah A. Aktivitas enzim laktase pada murid
sekolah dasar. Maj Kedok Indones 2001;51:154-6
27. Sofia D. Prevalens malabsorpsi laktosa murid SLTP
Negeri 7 Jakarta [thesis]. Jakarta: Department of Child
Health, Medical School, Univ. of Indonesia; 2002.
28. Apley. The child with abdominal pain. London: Blackwell
Scientific Publ; 1975. p. 3-54.
29. Walker WA, Hendricks KM. Pediatric Nutrition.
Philadelphia: WB Saunders; 1985.
30. Boediarso A. Sakit perut berulang. Proceedings of
the National Symposium of Badan Koordinasi
Gastroenterologi Anak Indonesia. In: Munyi R,
Abimanyu, Sofyan I, editors. Banjarmasin; 2000. p.
59-70
31. Van der Meer SB. Chronic recurrent abdominal pain in
school children [abstract].Tidjschr Kindergeneeskd
1993;61:69-75.
32. Thiessen PN. Recurrent abdominal pain. Pediatrics in
review 2002;23:39-46
33. Rings EHHM, Grand RJ, Buller HA. Lactose intoler-
ance and lactase deficiency in children. Pediatrics
1994;6:562-7.
34. Buller HA, Grand RJ. Lactose intolerance. Annu Rev
Med 1990;41:141-8.
35. American academy of pediatrics - committee on nutri-
tion. The practical significance of lactose intolerance
in children. Pediatrics 1978;62:240-5.
36. Buller HA, Rings EHHM, Montgomery RK, Grand
RJ. Clinical aspect of lactose intolerance in children
and adults. Scand J Gastroenterol 1991;26:73-80.
37. Montes RG, Perman JA. Lactose intolerance. Postgrad
Med 1991;89:175-84.
38. Hegar B, Buller HA. Breath hydrogen test in lactose
malabsorption. Paediatr Indones 1995;35:161-71
Published
2016-10-10
How to Cite
1.
Yohmi E, Boediarso A, Hadinegoro SR. Lactose malabsorption based on breath hydrogen test in children with recurrent abdominal pain. PI [Internet]. 10Oct.2016 [cited 22Nov.2024];44(6):215-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/781
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Received 2016-10-03
Accepted 2016-10-03
Published 2016-10-10
Accepted 2016-10-03
Published 2016-10-10
