Another condition with symptoms similar to IBS is intolerance to lactose, a sugar found in all dairy products.
All babies are able to digest lactose, the natural sugar found in milk. It is normal to lose this ability towards the end of childhood.
Due to a genetic mutation, which appears to have started in Ireland and possibly one or two other places in the world, almost all Northern Europeans maintain the ability to digest lactose even in adulthood. This is rather convenient because it means that we can drink milk and eat milk chocolate!
But not everyone can digest lactose. These people are lactose intolerant.
- 2 in 100 Northern Europeans are lactose intolerant
- 50 in 100 Jews are lactose intolerant
- More than 90 in 100 Asians and Black Africans are lactose intolerant, although only it is lower, at 75% in Tanzanians; and only about 10% of Sudanese people have this problem.
Lactose intolerance can, curiously, cause no symptoms at all. But it can cause really bad problems, particularly bloating, abdominal pain and diarrhoea. If you have lactose intolerance, you will need to try a special diet and see whether this helps you. But first it needs to be diagnosed.
There are two ways to diagnose lactose intolerance:
Lactose Hydrogen Breath Test
This test is similar to the lactulose hydrogen breath test.
You will be given a tablet containing the sugar lactulose (which is safe for diabetics to take) and asked to give a sample of breath every 15 mins for 2-3 hours. If the levels of hydrogen in your breath rise higher than average it is an indication that you may be suffering from an intolerance to lactose. If you are diagnosed as lactose-intolerant, your symptoms may be controlled by avoiding dairy products or by taking supplements which replace the natural lactase enzyme.
Duodenal biopsy sample test for lactase
A new way of testing for lactose intolerance is to check how much the bowel makes of the digestive enzyme lactase. All children have plenty of lactase. The loss of lactase as they get older is what causes lactose intolerance.
During a routine endoscopy, a small biopsy (sample of tissue) is taken from the lining of the small bowel. This is painless. The sample is analysed in the endoscopy room using special tests. It takes about 20 minutes to get a result. The result shows that you are either not lactose intolerant or that you are mildly or severely intolerant of lactose.
This test is a wonderful invention because it means that you do not have to undergo any prolonged breath tests. So if you are going to have an endoscopy anyway, discuss with your doctor whether this test is available.
At the London Gastroenterology Centre, we aim to ensure that we have this special test available wherever and whenever you have your endoscopy done. Just ask us in advance to make sure that we have the special kits available on the day!