Lactose intolerance in the differential diagnosis of uneasy infants

Lactose intolerance in the differential diagnosis of uneasy infants

Aim: Intestinal lactase deficiency is the most common carbohydrate malabsorption and digestive disorder. If lactase deficiencycoexists with gastrointestinal symptoms such as abdominal distension, flatulence, abdominal pain, diarrhea, vomiting and nausea,then the term “lactose intolerance” is used clinically. Uneasiness and excessive crying are frequently seen in the first 3 months oflife and constitute nearly 20% of the patients who are referred to a pediatrician. This study aims to perform a retrospective analysisof the complaints of patients who have been diagnosed with lactose intolerance.Material and Methods: The files of patients, who were diagnosed with lactose intolerance between October 2017 and May 2018 inDefalife Hospital Pediatrics Outpatient Clinic, were retrospectively reviewed.Results: A total of 38 patients, consisting of 23 males and 15 females are included to the study. The mean age of the patients was5.51±3.47 months (age range 1 to 18 months). 31% of the patients diagnosed with lactose intolerance were admitted to the hospitaldue to uneasiness and excessive crying, and all of the patients were previously diagnosed as having infantile colic.Conclusion: This study concludes that conducting tests for lactose intolerance might be beneficial in children that are presentedto the hospital due to unexplained crying after the fourth month, at which time there is an expectation of seeing an improvement incolic behavior.

___

  • 1. Semenza G. Anchoring and biosynthesis of stalked brush border membrane proteins: glycosidases and peptidases of enterocytes and renal tubuli. Annu Rev Cell Biol 1986;2:255–13.
  • 2. Heyman MB; Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics 2006;118:1279-86.
  • 3. Kim JS. Excessive crying: behavioral and emotional regulation disorder in infancy. Korean J Pediatr 2011; 54: 229-33.
  • 4. Reijneveld SA, Brugman E, Hirasing RA. Excessive infant crying: the impact of varying definitions. Pediatrics 2001;108:893-97.
  • 5. Barr RG, St. James-Roberts I, Keefe MR. New evidence on unexplained early infant crying: its origins, nature and management. Skillman, NJ: Johnson & Johnson Pediatric Institute, 2001.
  • 6. Barr RG, Young SN, Wright JH, et al. Differential calming responses to sucrose taste in crying infants with and without colic. Pediatrics 1999;103:68. 7. Wahlqvist ML. Lactose nutrition in lactase nonpersisters. Asia Pac J ClinNutr 2015;24:21–25.
  • 8. Harvey CB, Hollox EJ, Poulter M, et al. Lactase haplotype frequencies in Caucasians: association with the lactase persistence/non-persistence polymorphism. Ann Hum Genet 1998;62:215–23.
  • 9. Itan Y, Jones BL, Ingram CJ, et al. A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evol Biol 2010;10:36.
  • 10. Lebenthal E, Antonowicz I, Shwachman H. Correlation of lactase activity, lactose tolerance and milk consumption in different age groups. Am J Clin Nutr 1975;28:595–600.
  • 11. Welsh JD, Poley JR, Bhatia M, et al. Intestinal disaccharidase activities in relation to age, race, and mucosal damage. Gastroenterology 1978;75:847–55.
  • 12. Woteki CE, Weser E, Young EA. Lactose malabsorption in Mexican-American children. Am J Clin Nutr 1976; 29:19–24.
  • 13. Sahi T. Genetics and epidemiology of adulttype hypolactasia. Scand J Gastroenterol Suppl 1994;202:7–20.
  • 14. Wang Y, Harvey CB, Hollox EJ, et al. The genetically pro- grammed down-regulation of lactase in children. Gastroenterology 1998;114:1230–36.
  • 15. Antonowicz I, Lebenthal E. Developmental pattern of small intestinal enterokinase and disaccharidase activities in the human fetus. Gastroenterology 1977; 72:1299–1303.
  • 16. Buller HA, Van Wassenaer AG, Raghavan S, et al. New insights into lactase and glycosylceramidase activities of rat lactase-phlorizin hydrolase. Am J Phys 1989;257:616–23.
  • 17. Türkiye Nüfus ve Sağlık Araştırması (TNSA) (2013), Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Kalkınma Bakanlığı ve TÜBİTAK, Ankara, Türkiye. 18. Heine RG, AlRefaee F, Bachina P, et al. Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited. World Allergy Organ J 2017;10: 41.
  • 19. Di Palma JA, Narvaez RM. Prediction of lactose malabsorption in referral patients. Dig Dis Sci1988; 33:303–07.
  • 20. Suarez FL, Savaiano DA, Levitt MD. A comparison of symptoms after the consumption of milk or lactosehydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995;333:1– 4.
  • 21. Drugs.com. Lactose free diet. Available at: https:// www.drugs.com/cg/lactose-free-diet.html. Accessed, 2018
  • 22. Caballero B, Solomons NW, Torun B. Fecal reducing substances and breath hydrogen excretion as indicators of carbohydrate malabsorption. J Pediatr Gastroenterol Nutr 1983;2:487–90.
  • 23. Counahan R, Walker-Smith J. Stool and urinary sugars in normal neonates. Arch Dis Child 1976;51:517–20.
  • 24. Klemola T, Vanto T, Juntunen-Backman K, et al. Allergy to soy formula and to extensively hydrolized whey formula in infants with cow’s milk allergy: a prospective, randomized study with a follow up to the age of 2 years. J Pediatr 2002;140:219-24.
  • 25. Rudzeviciene O, Narkeviciute I, Eidukevicius R. Lactose malabsorption in young Lithuanian children with atopic dermatitis. Acta Paediatr 2004;93:482-6.
  • 26. Zeevenhooven J, Koppen IJ, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr 2017;20:1–13.
  • 27. Stahlberg MR, Savilahti E. Infantile colic and feeding. Arch Dis Child 1986; 61:1232-33.
  • 28. Miller JJ, McVeagh P, Fleet GH, et al. Effect of yeast lactase enzyme on ‘colic’ in infants fed human milk. J Pediatr 1990;117:261-63.
  • 29. Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet 2001;14:359-63.
  • 30. Vandenplas Y. Lactose intolerance. Asia Pac J ClinNutr 2015;24;9–13.
Annals of Medical Research-Cover
  • Yayın Aralığı: 12
  • Yayıncı: İnönü Üniversitesi Tıp Fakültesi
Sayıdaki Diğer Makaleler

Ectopic thyroid tissue with normally located thyroid gland

Zuhal KARACA KARAGÖZ, Feyzi KURT

Specificity and sensitivity of biotinidase activity measured from dried blood spot by colorimetric method

Nurgül ATAŞ, Meryem KARACA, Halil KAZANASMAZ

Natural course of non-surgical acute traumatic subdural hematomas: Retrospective analysis of 92 patients

Tayfun ÇAKIR, Dursun TÜRKOZ

Is MR imaging correlated with mid-term clinical results after arthroscopic all-inside meniscal repair?

Soner AKKURT, Serap DOĞAN, Ahmet GÜNEY, Erdal UZUN

Medico-legal examination of patients with developmental dysplasia of hip treated surgically due to late diagnosis

Mustafa KARAKAPLAN

Risk factors for axillary lymph node metastasis in breast cancer

Uzer KÜÇÜKTULU, Eray KURNAZ, Huseyin EKEN, Bilgin ÇELEBİ

Evaluation of the effect of apixaban on the primary intact intervertebral disc cell cultures

Necati KAPLAN, Numan KARAASLAN, İbrahim YILMAZ, Özkan ATEŞ, Feride SİNEM AKGÜN, Duygu Yaşar ŞİRİN, Abdullah Talha ŞİMŞEK, Hanefi ÖZBEK

Diagnostic value of “t sign” on MRCP-MIP imaging in the evaluation of pancreas divisum

Diğdem ÖZER, Kemal Murat HABERAL, Ömer Koray HEKİMOĞLU

Effect of amyloidosis and proteinuria on augmentation index in patients with familial mediterranean fever

Adem KÜÇÜK, Semi ÖZTÜRK, Cevat KIRMA, Ahmet Seyfeddin GÜRBÜZ, Ali Uğur USLU, Süleyman ÇAĞAN EFE, Elbis AHBAB

Predisposing factors for failure of conservative treatment in umbilical pilonidal sinus: A clinical experience

Ecem MEMİŞOĞLU