Under carbohydrate intolerance we mean the inability to digest certain carbohydrates. The cause is a lack of one or more enzymes of the intestine. Symptoms include diarrhea, bloating of the abdomen and flatulence. The diagnosis is made clinically and by the hydrogen (H2) breath test. The treatment consists in the elimination of the causative disaccharide in the diet.
Carbohydrate intolerance is a malabsorption syndrome.
Under carbohydrate intolerance we mean the inability to digest certain carbohydrates. The cause is a lack of one or more enzymes of the intestine. Symptoms include diarrhea, bloating of the abdomen and flatulence. The diagnosis is made clinically and by the hydrogen (H2) breath test. The treatment consists in the elimination of the causative disaccharide in the diet. Carbohydrate intolerance is a malabsorption syndrome. Pathophysiology disaccharides are normally disaccharidases (z. B. lactase, maltase, isomaltase, sucrase [invertase]) is cleaved into monosaccharides. These enzymes are found in the brush border of the small intestine cells. The undigested disaccharides are osmotically effective and lead to water and electrolyte retention in the intestinal lumen and in this way cause aqueous diarrhea. A bacterial fermentation of carbohydrates in the colon lead to the formation of gas (hydrogen, methane and Carbondioxid) and excessive flatulence, bloating, distension and abdominal pain. Etiology enzyme deficiencies can be Congenital (z. B. lack of lactase or sucrase-isomaltase) Acquired (primary) secondary Acquired lactase deficiency (primary hypolactasia in adults) is the most common form of carbohydrate intolerance is. The newborn, the Lactasespiegel are high and allow the milk digestion , For most ethnic groups (80% of blacks and Hispanics,> 90% of Asians) the levels decline after weaning so that older children and adults are no longer able to digest significant amounts of lactose. On the other hand, 80-85% of whites form in northwestern Europe throughout life lactase to digest and are thus able to milk and milk products. It is not clear why the normal state is referred to in> 75% of the world population as “deficiency”. A secondary lactase deficiency arises in damage to the small intestinal mucosa (e.g., Celiac disease, tropical sprue, acute intestinal infection -. [S gastroenteritis.). In children, a temporary secondary Disaccharidasemangel in intestinal infection and surgery can occur. If the underlying disease is eliminated, and the activity of the enzyme increases again. Symptoms and signs The symptoms of carbohydrate intolerance is similar for all Disaccharidasemangelzuständen. A child who does not tolerate lactose, continues to suffer from diarrhea and intake of milk does not increase. A concerned adult can develop after ingestion of lactose watery diarrhea, flatulence, nausea, abdominal cramps and Borborygmi. The patient takes early in life note that dairy products cause intestinal problems and avoids consequently the consumption of these products. Symptoms typically occur if you have taken more than 250-375 ml of milk. The diarrhea may be so severe that nutrients are carried away before they can be absorbed. The symptoms may be similar to irritable bowel syndrome, so confusion occur. Tips and risks Most people with lactase deficiency tolerated up to 250 to 375 ml of milk; Symptoms that occur after consuming much smaller amounts can, suggest a different diagnosis. Diagnosis Diagnosis is clinically provided confirmation is made by hydrogen breath test Lactose intolerance is usually diagnosed using a careful medical history and appropriate dietary exposure. Most patients report diarrhea and / or gas after drinking milk and milk products; other symptoms such as rash, shortness of breath or other anaphylactic symptoms (especially in infants and children), point to a cow’s milk allergy. A milk allergy is rare in adults and can also lead to vomiting and reflux symptoms that are not are manifestations of a carbohydrate intolerance. The diagnosis is also thought that if the chair in chronic or intermittent diarrhea is acidic (pH <6). The H2 breath test or a lactose tolerance test confirms the diagnosis. The hydrogen breath test 50 g of lactose are administered orally and the hydrogen formed by the bacterial metabolism of lactose not digested with a measuring instrument 2, 3 and 4 h determined after recording. Most affected patients show an increase of exhaled hydrogen> 20 ppm above normal. Sensitivity and specificity are> 95%. The lactose tolerance test is about 75% less sensitive, although the specificity is> 95%. Lactose (1.0-1.5 g / kg body weight) is administered orally. Serum glucose is 60 min before to 120 min determined after recording. Lactose Intolerant patients develop diarrhea, bloating and discomfort within 20-30 min, and their serum glucose levels do not rise to> 20 mg / dL (<1.1 mmol / L) from baseline. A therapeutic food restriction Carbohydrate is best controlled by sacrificing non-absorbable sugar in the diet (for. Example, ingestion of a lactose-free diet with lactase deficiency). But since varying the amount of lactose malabsorption strong, some patients can record up to 375 ml (18 g lactose) in milk a day without symptoms. Yogurt is usually tolerated because it contains a not to be underestimated amount of lactase, which is derived from the intrinsic Lactobacilli. Cheese contains lower amounts of lactose than milk and is often tolerated, depending on the amount ingested. For symptomatic patients who want to drink milk, the milk can be predigested by the addition of commercially prepared lactase, such pretreated milk is now available. Enzyme supplements should be administered to the patient at the same time the food restriction is maintained. Patients with lactose intolerance need to supplement calcium received (1200-1500 mg / day). Summary A Disaccharidmangel (usually of lactase) may be purchased or, rarely, be innate. Undigested disaccharides such as lactose lead to osmotic stress, which causes diarrhea. Intestinal bacteria metabolize some undigested disaccharides and produce gases that cause bloating and flatulence. The clinical diagnosis is confirmed by a hydrogen breath test. Food restriction is the appropriate treatment usually.