Controversy still exists as to the incidence, role and impact of lactose sensitivity in inflammatory bowel disease. The thesis shows that there is a higher than previously reported incidence of lactose sensitivity determined by a combination of genotype, breath test and symptoms after a lactose challenge. Lactose sensitivity in patients with inflammatory bowel disease who are in remission is 70%. There was no difference compared to healthy volunteers in terms of lactase genotyping; however there was a significantly greater prevalence of positive breath test and symptoms after lactose challenge. This suggests that lactose sensitivity in inflammatory bowel disease is related to the disease itself or a consequence of it and not due to a genetic predisposition. A significant proportion of inflammatory bowel disease patients [16%] are methane producers which warrants further investigation. A pilot study of reduced lactose intake in patients with Crohn’s disease and lactose sensitivity, who were in remission, showed a promising improvement in symptoms reported and quality of life scores. The Real-Time Polymerase Chain Reaction is simple and quick compared to Restrictive Fragment Length Polymorphism for assessing the lactase genotype. The Quintron MicroLyzer to assess breath samples after lactose challenge is preferred to the hand held Micro H2 meter. This detects methane in addition to hydrogen and without this a number of cases of lactose sensitivity would be II missed. It may be possible to predict a negative breath test with the absence of any GI symptoms after a breath test and vice-versa a positive breath test is very likely if multiple GI symptoms are reported. The ‘hidden’ lactose in drugs used to treat inflammatory bowel disease and co-existing conditions should be considered as it is present in many drugs and can make a significant contribution to the amount of lactose ingested; lactose free alternatives are widely available.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:585340 |
| Date | January 2013 |
| Creators | Eadala, Praveen |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/53992/ |
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