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A Comparison Between Lactose Breath Test and Quick Test on Duodenal Biopsies for Diagnosing Lactase Deficiency in Patients With Self-reported Lactose Intolerance

Furnari, Manuele MD*; Bonfanti, Daria MD*; Parodi, Andrea MD, PhD*; Franzè, Jolanda MD; Savarino, Edoardo MD, PhD*; Bruzzone, Luca MD*; Moscatelli, Alessandro MD*; Di Mario, Francesco MD; Dulbecco, Pietro MD*; Savarino, Vincenzo MD*

Journal of Clinical Gastroenterology: February 2013 - Volume 47 - Issue 2 - p 148–152
doi: 10.1097/MCG.0b013e31824e9132
ALIMENTARY TRACT: Original Articles

Background: A lactose breath test (LBT) is usually used to diagnose lactase deficiency, and a lactose quick test (LQT) has been proposed as a new test on duodenal biopsies to detect this disorder.

Goals: We aimed to assess the diagnostic accuracy of LBT and LQT and their ability to predict the clinical response to a lactose-free diet in patients with self-reported lactose intolerance.

Study: Fifty-five patients (age 47±14 y; M/F 15/36) underwent upper gastrointestinal endoscopy and 25g-LBT. Two duodenal biopsies were taken to determine lactase deficiency (normal, mild, or severe) by LQT and to rule out other causes of secondary lactose malabsorption. Patients with a positive LBT and normal LQT also underwent a glucose breath test to exclude small intestinal bacterial overgrowth as a cause of the former result. The severity of gastrointestinal symptoms was measured with a GSS questionnaire, under basal condition and 1 month after a lactose-free diet.

Results: Lactose malabsorption was detected in 31/51 patients with LBT and in 37/51 patients with LQT (P=NS). Celiac disease was found in 2 patients. Two LBT+ patients showed a positive glucose breath test for small intestinal bacterial overgrowth. Eight patients had a mild hypolactasia by LQT and a negative LBT, but they had a significant improvement of symptoms after diet. LQT and LBT were concordant in 83% of cases and predicted the response to a lactose-free diet in 98% and 81% of the cases, respectively (P=0.03).

Conclusions: LQT is as sensitive as LBT in detecting lactase deficiency; however, it seems to be more accurate than LBT in predicting the clinical response to a lactose-free diet.

*Department of Internal Medicine, Gatroenterology Unit, University of Genoa, Genoa

Gastroenterology Unit, University of Parma, Parma, Italy

M.F. and D.B. have contributed equally to the article.

M.F. and D.B.: writing the manuscript, contributed to data acquisition, and participated in the statistical analysis; A.P., J.F., and E.S.: designed the study and contributed to data acquisition; L.B. and A.M.: contributed to patient management; F.D.M., P.D., and V.S.: participated in the writing of the manuscript and data acquisition. All authors have seen and approved the final version of the manuscript.

The authors declare that they have nothing to disclose.

Reprints: Vincenzo Savarino, MD, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, no. 6, 16132 Genoa, Italy (e-mail:

Received November 8, 2011

Accepted February 3, 2012

© 2013 Lippincott Williams & Wilkins, Inc.