Nietolerancja laktozy - klasyfikacja i diagnostyka

Lactose intolerance is one of the most common gastroenterological problems that primary care physicians have to deal with. According to underlying cause there are three main types of lactose intolerance. Congenital lactose intolerance is extremely rare, however serious clinical entity. Clinical symptoms appear after first milk feeding of a newborn. Lack of appropriate diagnosis and/or therapeutic intervention may lead to death. Secondary lactose intolerance accompanies the diseases causing the damage of apical surface of enterocytes, where lactase is located. Lactase intolerance is reversible and ceases with the regeneration of intestinal mucosa. Primary lactose intolerance occurs most frequently and is associated with adult-type hypolactasia. It is physiological condition, its predispositions are inherited in an autosomal recessive manner. It affects the majority of the world population. With no regard to underlying cause, lactose intolerance symptoms comprise abdominal pain, diarrhea, bloating, borborygmi and flatus and are associated with the consumption of lactose containing products, mainly dairy ones. The diagnostic methods for lactose intolerance detection may be divided into direct and indirect. The measurement of lactase activity in jejunal biopsy specimen is the direct method. Indirect methods comprise hydrogen/hydrogen-methane breath test, oral lactose tolerance test, elimination diet, stool acidity test and molecular analysis of the lactase gene polymorphism. Due to the high sensitivity and specificity as well as relative ease of completion, hydrogen/hydrogen-methane breath test is considered to be the gold standard for the diagnosis of lactose intolerance.