Lactose intolerance diagnostic study of choice: Difference between revisions
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{{Lactose intolerance}} | {{Lactose intolerance}} | ||
{{CMG}} {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] | {{CMG}} {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] | ||
== Overview == | == Overview == | ||
* The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice." | * The page name should be '''"Diagnostic study of choice for [disease name]"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice." | ||
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** Noninvasive | ** Noninvasive | ||
** Undigested lactose is fermented by intestinal flora to carbon dioxide, hydrogen and methane and then they are eliminated via the lungs. | ** Undigested lactose is fermented by intestinal flora to carbon dioxide, hydrogen and methane and then they are eliminated via the lungs. | ||
** False negative result | ** False negative result is due to: | ||
*** Taking antibiotics within previous one month | *** Taking antibiotics within previous one month | ||
*** Inhibition of bacterial activity by more acidic environment of colon | *** Inhibition of bacterial activity by more acidic environment of colon | ||
*** Underlying lung disease | *** Underlying lung disease | ||
**False positive result | **False positive result | ||
***Small bowel bacterial overgrowth: | |||
****Earlier rise in breath hydrogen level after ingestion of lactose ( less than 60 minutues )_ | |||
** Avoiding cigarette smoking and exercise 2 hours before lactose hydrogen test, because they cause hyperventilation and they can change accuracy of test<ref name="pmid16567886">{{cite journal |vauthors=Ghoshal UC, Ghoshal U, Das K, Misra A |title=Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time |journal=Indian J Gastroenterol |volume=25 |issue=1 |pages=6–10 |year=2006 |pmid=16567886 |doi= |url=}}</ref> | ** Avoiding cigarette smoking and exercise 2 hours before lactose hydrogen test, because they cause hyperventilation and they can change accuracy of test<ref name="pmid16567886">{{cite journal |vauthors=Ghoshal UC, Ghoshal U, Das K, Misra A |title=Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time |journal=Indian J Gastroenterol |volume=25 |issue=1 |pages=6–10 |year=2006 |pmid=16567886 |doi= |url=}}</ref> | ||
Revision as of 16:45, 4 December 2017
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Lactose Intolerance Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Lactose intolerance diagnostic study of choice On the Web |
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American Roentgen Ray Society Images of Lactose intolerance diagnostic study of choice |
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Risk calculators and risk factors for Lactose intolerance diagnostic study of choice |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3] [4] [5] [6] [7]
Overview
- The page name should be "Diagnostic study of choice for [disease name]", with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
- Goal:
- To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
- To describe the gold standard test for the diagnosis of [disease name].
- To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
- As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
- Remember to create links within WikiDoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example, if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links, click here.
- Remember to follow the same format and capitalization of letters as outlined in the template below.
- You should include the name of the disease in the first sentence of every subsection.
Diagnostic Study of Choice
Template statements
Gold standard/Study of choice:
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Lactose Intolerance Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Lactose intolerance diagnostic study of choice On the Web |
|
American Roentgen Ray Society Images of Lactose intolerance diagnostic study of choice |
|
Risk calculators and risk factors for Lactose intolerance diagnostic study of choice |
) The incidence of lactose maldigestion is usually determined in adults by the administration in the fasting state of a 50-g dose of lactose in water, the equivalent of that in 1 L of milk.[1]
- Small bowel biopsy such as jujenal or deodenal biopsy is the gold standard test for the diagnosis of lactose intolerance via investigation of lactase enzyme activity.[2]
- Low lactase activity in small bowel biopsy is confirmatory of lactose intolerance.
- Nowadays, small bowel biposy is rarely performed and it is substitued with noninvasive diagnostic tests such as lactose tolerance test and lactose breath hydrogen test.
- The diagnostic study of choice for lactose intolerance is lactose breath hydrogen test.[3][4]
- Noninvasive
- Undigested lactose is fermented by intestinal flora to carbon dioxide, hydrogen and methane and then they are eliminated via the lungs.
- False negative result is due to:
- Taking antibiotics within previous one month
- Inhibition of bacterial activity by more acidic environment of colon
- Underlying lung disease
- False positive result
- Small bowel bacterial overgrowth:
- Earlier rise in breath hydrogen level after ingestion of lactose ( less than 60 minutues )_
- Small bowel bacterial overgrowth:
- Avoiding cigarette smoking and exercise 2 hours before lactose hydrogen test, because they cause hyperventilation and they can change accuracy of test[5]
- 50 g of lactose in adults and 2 g/kg (maximum dose 25 g) in children in fasting state is administered
- Breath hydrogen level and associated symtoms such as bloating, diarrhea and abdominal pain are checked at baseline and at 30 minute intervals for three hours
- Lactose malabsorption and intolerance are diagnosed based on a rise in hydrogen concentration of 20 ppm ( parts per million) and persentation of symptoms in compare to baseline
- Lactose tolerance test
- The [name of investigation] should be performed when:
- The patient presented with symptoms/signs 1. 2, 3.
- A positive [test] is detected in the patient.
- [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
- The diagnostic study of choice for [disease name] is [name of investigation].
- There is no single diagnostic study of choice for the diagnosis of [disease name].
- There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
- Lactose intolerance is mainly diagnosed based on clinical presentation, such as abdominal pain, bloating, flatulence, and lactose breath hydrogen test.
- Investigations:
- Among patients who present with clinical signs of lactose intolerance, the lactose breath hydrogen test is the most specific test for the diagnosis.
- Among patients who present with clinical signs of , the is the most sensitive test for diagnosis.
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
The comparison table for diagnostic studies of choice for lactose intolerance[6][7][8]
| Sensitivity | Specificity | |
|---|---|---|
| Lactose breath hydrogen test | 88 | 85 |
| Genetic test for primary lactase deficiency | 88 | 90 |
| Endoscopic duodenal biopsy | 95 | 100 |
| Lactose tolearance test | 94 | 90 |
✔= The best test based on the feature
Diagnostic results
The following result of [investigation name] is confirmatory of [disease name]:
- Result 1
- Result 2
Sequence of Diagnostic Studies
The [name of investigation] should be performed when:
- The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
- A positive [test] is detected in the patient, to confirm the diagnosis.
Diagnostic Criteria
- Here you should describe the details of the diagnostic criteria.
- Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
- Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
- Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
- Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
- To view an example (endocarditis diagnostic criteria), click here
- If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
- You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
- [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
- There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
- [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
IF there are clear, established diagnostic criteria:
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
- The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
- The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
- There are no established criteria for the diagnosis of [disease name].
References
- References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
- For information on how to add references into your page, click here.
- ↑ Scrimshaw NS, Murray EB (1988). "The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance". Am. J. Clin. Nutr. 48 (4 Suppl): 1079–159. PMID 3140651.
- ↑ Mattar R, de Campos Mazo DF, Carrilho FJ (2012). "Lactose intolerance: diagnosis, genetic, and clinical factors". Clin Exp Gastroenterol. 5: 113–21. doi:10.2147/CEG.S32368. PMC 3401057. PMID 22826639.
- ↑ Law D, Conklin J, Pimentel M (2010). "Lactose intolerance and the role of the lactose breath test". Am. J. Gastroenterol. 105 (8): 1726–8. doi:10.1038/ajg.2010.146. PMID 20686460.
- ↑ Ghoshal UC (2011). "How to interpret hydrogen breath tests". J Neurogastroenterol Motil. 17 (3): 312–7. doi:10.5056/jnm.2011.17.3.312. PMC 3155069. PMID 21860825.
- ↑ Ghoshal UC, Ghoshal U, Das K, Misra A (2006). "Utility of hydrogen breath tests in diagnosis of small intestinal bacterial overgrowth in malabsorption syndrome and its relationship with oro-cecal transit time". Indian J Gastroenterol. 25 (1): 6–10. PMID 16567886.
- ↑ Kuokkanen M, Myllyniemi M, Vauhkonen M, Helske T, Kääriäinen I, Karesvuori S, Linnala A, Härkönen M, Järvelä I, Sipponen P (2006). "A biopsy-based quick test in the diagnosis of duodenal hypolactasia in upper gastrointestinal endoscopy". Endoscopy. 38 (7): 708–12. doi:10.1055/s-2006-925354. PMID 16761211.
- ↑ Marton A, Xue X, Szilagyi A (2012). "Meta-analysis: the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C/T-13910". Aliment. Pharmacol. Ther. 35 (4): 429–40. doi:10.1111/j.1365-2036.2011.04962.x. PMID 22211845.
- ↑ Mattar R, de Campos Mazo DF, Carrilho FJ (2012). "Lactose intolerance: diagnosis, genetic, and clinical factors". Clin Exp Gastroenterol. 5: 113–21. doi:10.2147/CEG.S32368. PMC 3401057. PMID 22826639.