The relationship between lactose ingestion and gastrointestinal (GI) symptoms is controversial, and diagnostic criteria for lactose maldigestion vary. The aim of this study was to assess the GI symptoms associated with ingesting milk and to evaluate diagnostic criteria for lactose maldigestion in children. Twenty-five children (10 males) age 3 to 17 years with lactose maldigestion diagnosed by breath hydrogen testing were studied. Subjects ingested 240 ml of milk daily for 14 days. Symptom diaries were used to rate the severity of abdominal pain, bloating, flatus, and diarrhea. The cumulative symptom scores from the 14 day study period were compared for children with a greater than 20 ppm rise to those with a 10-20 ppm rise in breath H2 concentration. The data are shown in mean ±SE. Table

Table 1 No caption available.
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We conclude that ingestion of 12 gm lactose daily does not cause a significant increase in abdominal pain in children with varying lactose breath hydrogen test results. However, other symptoms associated with lactose maldigestion may be experienced to a greater degree by children with a greater than 20 ppm rise in breath hydrogen concentration after a 1 gm/kg lactose challenge compared to those with less than a 20 ppm rise. Therefore, a greater than 20 ppm increase in breath hydrogen concentration should be the diagnostic criterion for clinically relevant lactose maldigestion in children.

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