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Lactose intolerance is a common condition caused by lactase deficiency and may result in symptoms of lactose malabsorption (bloating, flatulence, abdominal discomfort, and change in bowel habits). As current data is limited, the aim of our study was to assess the efficacy of probiotics with a β-galactosidase activity on symptoms of lactose malabsorption and on the lactose hydrogen breath test (LHBT). The study group comprised eight symptomatic female patients with a positive LHBT. Patients were treated for 6 months with a probiotic formula with β-galactosidase activity (Bio-25, Ambrosia-SupHerb, Israel). All patients completed a demographic questionnaire as well as a diary for the assessment of symptom severity and frequency at entry, every 8 weeks, and at the end of the treatment period. Measurements of hydrogen (H2) levels (parts per million, ppm) at each of these time points were also performed. End points were a decrease of 50% in symptom severity or frequency, and the normalization (decrease below cutoff point of 20 ppm) of the breath test. Mean age and mean body mass index (BMI) were 36.4 ± 18.6 years and 23.2 kg/m2, respectively. Compared to baseline scores, the frequency of most symptoms, and the severity of bloating and flatulence, improved after treatment. Normalization of LHBT was obtained in only two patients (25%). In this pilot study, Bio-25, a unique formulation of probiotics with β-galactosidase activity, demonstrated symptom resolution in most patients with lactose malabsorption. A larger randomized trial is warranted to confirm these preliminary findings.

The lactose breath test (LBT) is the standard technique for diagnosis of lactose malabsorption. However, it is time-consuming, strenuous for the patient and has been reported to have low sensitivity. The lactose intolerance quick test (LIQT) measures lactase activity in duodenal biopsies and may be performed as part of upper gastrointestinal endoscopy. The purpose of this study was to assess the role of the LBT and LIQT in the case management of suspected lactose malabsorption. The study group included 69 consecutive patients evaluated by the LBT followed by the LIQT. The test results were compared, and the sensitivity, specificity, and predictive values of the LBT were calculated. Mean age of the patients was 54.4 years, male/female ratio was 1:3, and mean body mass index was 25.2. None had celiac disease on duodenal biopsy. The LIQT was positive for hypolactasia in 55 patients (80 %): mild in 14 (25 %) and severe in 41 (75 %); 10 (18 %) were symptomatic during the LBT. The LBT was positive for lactose malabsorption in 32 patients (46 %). Of the 37 patients with normal findings on the LBT, 24 (65 %) had positive findings on the LIQT: 11 (30 %) mild hypolactasia, 13 (35 %) severe hypolactasia. In one case, the LBT was positive and the LIQT was negative. The LBT had a sensitivity of 56 %, specificity 93 %, positive predictive value 97 %, and negative predictive value 35 %. The LBT may serve as a diagnostic screening tool for lactose malabsorption. Symptomatic patients with negative LBT results should be referred for second-line testing with the LIQT.

OBJECTIVE To determine normative gastric emptying rates for the continuous breath test and to compare its findings with gastric scintigraphy in healthy volunteers and dyspeptic patients. METHODS A standard 250 kcal meal double-labeled with 1 mCi 99mTc colloid and 100 μg nonradioactive 13C-octanoic acid was administered to 20 healthy individuals and 22 dyspeptic patients attending a tertiary medical center in 2009-2010. Gastric emptying rate was measured simultaneously with sequential gastric scintigraphy and the continuous breath test. The results of the healthy controls were used as a normative reference. The findings of the two tests were analyzed by linear regression and κ statistics. In addition, the gastric half-emptying times (T ½) were compared by a κ test for evaluating the agreement of normal/abnormal results in both methods. RESULTS Background features were as follows: healthy individuals - 15 men/5 women, mean age 44.9 ± 14 years and mean BMI 26.8 ± 3.5; dyspeptic patients - 5 men/17 women, mean age 58.0 ± 13 years and mean BMI 25.3 ± 5.5. The upper limit of normal for gastric half-emptying time (T ½) was 140 min by the breath test. The linear correlation of T ½ between the methods was 0.64. The agreement of normal/abnormal T ½ between the methods was 0.65. CONCLUSION The continuous breath test may be a suitable method for the evaluation of gastric emptying. A larger study is required to determine its feasibility as the standard of care in dyspeptic patients.