Is lactose intolerance implicated in the development of post-infectious irritable bowel syndrome or functional diarrhoea in previously asymptomatic people?

• Published in: European journal of gastroenterology & hepatology Vol. 14; no. 11; pp. 1225 - 1230
• Main Authors: Parry, Sally D, Barton, J Roger, Welfare, Mark R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-11-2002; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Bacterial Infections - complications; Biological and medical sciences; Breath Tests; Case-Control Studies; Cohort Studies; Colonic Diseases, Functional - diagnosis; Colonic Diseases, Functional - microbiology; Diarrhea - diagnosis; Diarrhea - microbiology; Female; Gastroenteritis - complications; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lactose Intolerance - diagnosis; Lactose Intolerance - microbiology; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Prospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Food intolerance; Pathogenesis; Gastroenteritis; Diarrhea; lactose intolerance; Infection; Lactose; Breath test; functional diarrhoea; Irritable bowel syndrome; Bacteriosis; Digestive diseases; Intestinal disease; Complication; Gastric disease
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/00042737-200211000-00010

OBJECTIVE The relationship between lactose intolerance and post-infectious irritable bowel syndrome (IBS) in adults is uncertain. Bowel symptoms may persist after bacterial gastroenteritis and as post-infectious IBS. Acquired lactose intolerance may follow viral enteric infections in children. We compared the frequency of lactose intolerance after bacterial gastroenteritis in adults with and without symptoms of IBS or functional diarrhoea at 3–6-months’ follow-up.
DESIGN A prospective cohort study was conducted.
METHODS All subjects with bacterial gastroenteritis confirmed by stool culture from the microbiology laboratory and without prior IBS or functional diarrhoea were eligible to participate. IBS and functional diarrhoea were diagnosed via self-completed Rome II modular questionnaires. Lactose intolerance was determined from a rise in breath hydrogen and plasma glucose and symptoms.
RESULTS One hundred and twenty-eight subjects with bacterial gastroenteritis were followed prospectively, from which a smaller cohort of 42 subjects took part in this study. The cohort was comprised of 24/25 subjects who developed post-infectious IBS (n = 16) or functional diarrhoea (n = 8) (9 male, 15 female) and 18 random controls (8 male, 10 female) chosen from the group without IBS or functional diarrhoea. The mean age of the subjects was 44.4 years (range 25–76 years). In the group with functional diarrhoea or IBS, four subjects had failure of the plasma glucose to rise but none had abnormal glucose hydrogen breath tests. In the control subjects, one had a positive combined test and six had failure of plasma glucose to rise alone. No subject developed symptoms during the test.
CONCLUSIONS Bacterial gastroenteritis did not cause persistent lactose intolerance in our study population. Lactose intolerance does not appear to be implicated in the aetiology of post-infectious bowel symptoms, including IBS. Advice to avoid dairy products in patients presenting with post-infectious IBS on the basis that they may have lactose intolerance appears unnecessary in patients from northern England.