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It is the most important source of energy during the first year of a humans life, providing almost half the total energy requirement of infants.
To be absorbed,lactose needs to be broken down in the intestine by a galactosidase and lactase phloritzin,generall called lactase
Lactase is found most abundantly in the jejunum (at the beginning of the small intestine), and it specifically only hydrolyses lactose. It is found at the tip of the intestinal villi. The gene coding for lactase is located on chromosome 2
It is the inability to digest lactose due to deficieny of lactase so: Undigested lactose can exert an osmotic effect, drawing water into the small intestine. This may accelerate the passage of intestinal contents into the large intestine, and so contribute to the diarrhea associated with lactose intolerance. Colonic bacteria can then digest the lactose, forming first short-chain carboxylic acids (e.g., propionic, acetic, formic, and lactic acids). Formic acid is then cleaved by formic lyase to yield hydrogen gas and carbon dioxide. Furthermore, colonic bacteria may then form methane from the carbon dioxide and hydrogen gas. The result is copious amounts of gas in the large intestine, leading to the flatulence and "rumblings" associated with lactose intolerance .
Lactose intolerance
Congenital lactase deficiency
low intestinal lactase during mid-childhood (approximately at age 5 yrs) This finding is most prominent in Asian and African populations; rare in Caucasians of Scandinavian background Molecular basis remains unknown
population) Characterized by the absence of lactase activity in the small intestine, with normal histologic findings A gene located on the same chromosome of the lactase gene, is responsible for CLD Affected infants have diarrhea from birth, hypercalcemia and nephrocalcinosis
quadrant
Bloating Flatulence Diarrhea
Vomiting
Stools are usually bulky, frothy and watery
gastric emptying and reduce the severity of symptoms Rapid intestinal motility rapid movement of sugar are more symptomatic Individuals have variable sensitivity to the abdominal distention produced when undigested lactose stimulates an influx of water into the lumen or to gas production
Diverticulitis
Celiac sprue Acute gastroenteritis
Giardiasis
Test absorption (lactose absorption test) or malabsorption (lactose breath hydrogen test) Lactose tolerance test Oral administration of 50 gram lactose Blood glucose levels 0, 60 and 120 min Increase of blood glucose by less than 20mg/dl + symptoms diagnostic False negative diabetes, bacterial overgrowth, delayed gastric emptying Sensitivity of 75%, specificity of 96%
Lactose breath hydrogen test Oral lactose (2g/kg) Breath hydrogen sampled at baseline and at 30 min intervals for three hours Breath hydrogen value of 10ppm normal, 10-20ppm indeterminate unless symptomatic, >20ppm diagnostic False positive recent smoking, false negative recent use of antibiotics, lung disorders, 1% non-hydrogen producers
abnormal intestinal mucosa or bacterial overgrowth, both of which require further evaluation by appropriate diagnostic tests
Normal breath hydrogen test psychologic factors,
1-hydrogen breath test. 2-stool acidity test. 3-lactose tolerance test. 4-milk tolerance test. 5-dietary elimination. 6-procedures. 7-histologic findings 8-smalll bowel biobsy.
Symptoms:
Abdominal pain - cramps, often localised to the per-umbilical area or lower quadrant Bloating - caused by the formation of gases that expand in the warm conditions of the digestive system Flatulence - caused by the gases produced by the bacteria. H2S is the gas associated with the odour . Diarrhea - stools are usually bulky, frothy and watery Vomiting - particularly adolescents Nausea - may be present, probably due to acidity and gases escaping backwards Weight loss - if kept unattended Malnutrition - especially in babies
In the absence of a correctable underlying disease, the treatment includes four general principles:
Reduced dietary lactose intake Substitution of alternative nutrient sources to maintain
energy and protein intake Administration of a commercially available enzyme substitute Maintenance of calcium intake
There is no cure for lactose intolerance, but you can treat your symptoms by limiting or avoiding milk products. Some people use milk with reduced lactose, or they substitute soy milk and soy cheese for milk and milk products. Some people who are lactose-intolerant can eat yogurt without problems, especially yogurt with live cultures. You can also take dietary supplements called lactase products that help digest lactose. In time, most people with lactose intolerance get to know their bodies well enough to avoid symptoms. Lactose intolerance is usually treated through the diet, By not eating or drinking more dairy products than the body can handle, or choosing products with low levels of lactose, the symptoms can be controlled. The lactase enzyme can also be ingested together with the food to make the lactose more digestible.