Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.797
Peer-review started: October 17, 2022
First decision: November 11, 2022
Revised: December 2, 2022
Accepted: January 5, 2023
Article in press: January 5, 2023
Published online: February 6, 2023
Self-reported lactose intolerance (LI) has been known to have a high prevalence in Asian people. However, there has been no recent report in Japan regarding the prevalence of lactose malabsorption (LM). Some literature shows that colonic adaptation by daily milk or lactose ingestion reduces LI symptoms in patients with LM, but such treatment has not been reported in Japan.
According to the literature from Western countries, patients with LM who underwent milk or lactose loading therapy were required to ingest large volumes of milk within a short period. Applying the same treatment to Japanese people is considered to carry a high risk for abdominal symptoms during the treatment, due to less habitual consumption of milk than Western people. In this study, we implemented an original method of milk loading without affecting daily life of study subjects.
The aim of this study was to examine the efficacy of incremental cow’s milk loading for treating patients with LM.
We selected subjects with LI symptoms using a questionnaire, and the selected subjects underwent a 20 g lactose hydrogen breath test (LHBT) for diagnosis of LM. We then conducted the treatment of incremental loads of cow’s milk on the subjects diagnosed with LM, starting from 30 mL and increasing up to 200 mL at 4-7 d intervals. After the treatment, improvement of symptoms and LM diagnostic value of LHBT were investigated. Stool samples pre- and post-treatment were examined for changes in the intestinal microbiota using 16S rRNA sequencing.
By LHBT, LM was diagnosed in 35 (76%) out of 46 subjects with LI selected using the questionnaire. Improvement of abdominal symptoms after the treatment was seen in 29 (91%) out of 35 subjects with LM. The diagnostic value measured in LHBT before and after the treatment improved in 10 (35%) out of 29 subjects with reduced symptoms, and no change was observed in 16 (55%) subjects. Analysis of fecal microbiota showed a significant increase of Blautia in 7 subjects who became symptom-free after the treatment.
Incremental loads of cow’s milk that are commercially available is a useful treatment for LM without affecting daily lives of Japanese people.
The incremental loads of cow’s milk can be widely utilized for LM patients, as well as improve their quality of life. We would like to further verify the efficacy of the same treatment in a longer term study.