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Visceral hypersensitivity, gas production worsen lactose intolerance symptoms in IBS patients
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Patients with IBS and visceral hypersensitivity are more likely to experience lactose intolerance symptoms, particularly bloating, according to recent results.
Researchers administered a 20-g lactose hydrogen breath test (LHBT) to 277 patients with IBS and 64 matched healthy controls, and measured symptoms of lactose intolerance (LI). Patients with two consecutive breath samples indicating hydrogen production greater than 20 ppm above basal values were considered to have lactose malabsorption (LM).
LM occurred similarly, while LI was more common in IBS patients (53.8% of cases v. 28.1%; P<.001), as were bloating (39% vs. 14.1%; P<.001), borborygmi (39% vs. 21.9%; P=.01), pain (31.4% vs. 10.9%; P=.001) and diarrhea (28.5% vs. 9.4%; P=.001).
Among 199 cases and 40 controls with available data on abdominal girth before and after LHBT, participants had similar girth at baseline. The proportion of patients experiencing distention after lactose ingestion, plus absolute girth increment, was not significantly different according to IBS status. Relevant bloating occurred in 39% of patients; 58% of them had distention.
Barostat studies used to determine rectal sensitivity in 74 cases and 64 controls showed that IBS patients had lower rectal sensory thresholds. This included initial sensation (P=.011), urge to defecate (P=.006) and pain/discomfort (P=.001). Hypersensitivity was observed in 20.3% of the group.
Multivariate analysis indicated significant associations between hydrogen production and borborygmi (OR=12.37; 95% CI, 3.34-45.83) and bloating (OR=2.19; 95% CI, 1.09-4.39), but not distention (P=.673). Investigators also noted associations between visceral hypersensitivity and bloating (OR=6.61; 95% CI, 1.75-25) and overall LI symptoms (OR=3.78; 95% CI, 1.3-10.99).
Mark Fox
“These findings will help clinicians provide a clear, evidence-based explanation for symptoms of food intolerance and IBS to their patients,” researcher Mark Fox, MD, professor and consultant gastroenterologist in the gastroenterology and hepatology division at University Hospital Zurich, told Healio.com. “On the one hand, the findings demonstrate how gas production related to the fermentation of certain foods in the bowel can cause bloating and other digestive problems. On the other hand, the paper shows how heightened visceral sensitivity in IBS patients can make even normal levels of gas production seem very unpleasant.”
Disclosure: The researchers report no relevant financial disclosures.
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