Lactose intolerance but not lactose maldigestion is more frequent in patients with irritable bowel syndrome than in healthy controls: A meta-analysis

Péter Varjú, Noémi Gede, Zsolt Szakács, Péter Hegyi, Irina Mihaela Cazacu, Dániel Pécsi, Anna Fábián, Zoltán Szepes, Áron Vincze, Judit Tenk, Márta Balaskó, Zoltán Rumbus, András Garami, Dezső Csupor, József Czimmer, Péter Varjú, Noémi Gede, Zsolt Szakács, Péter Hegyi, Irina Mihaela Cazacu, Dániel Pécsi, Anna Fábián, Zoltán Szepes, Áron Vincze, Judit Tenk, Márta Balaskó, Zoltán Rumbus, András Garami, Dezső Csupor, József Czimmer

Abstract

Background and purpose: Irritable bowel syndrome (IBS) affects 10%-20% of the adult population and is characterized by abdominal symptoms without relevant organic disease. There are numerous clinical trials available investigating the relationship between IBS, lactose maldigestion (LM), and lactose intolerance (LI), but there have been no meta-analyses on this topic yet. We aimed to assess the prevalence of LM, objective and subjective (self-reported) LI in IBS patients compared to healthy controls (HC) without IBS.

Methods: A systematic literature search was conducted up to 24 April 2018 in PubMed, Embase, and Cochrane Library. Adult IBS patients had to be diagnosed according to the Rome criteria or other well-defined criteria system. We enrolled controlled studies including healthy adult participants without IBS, as control group. Odds ratios with 95% confidence intervals were calculated.

Key results: Altogether 14 articles were suitable for statistical analyses. IBS patients reported themselves significantly more frequently lactose intolerant than HCs (odds ratio [OR] = 3.499; 95% confidence interval [CI] = 1.622-7.551). Generally, there was no significant difference in the prevalence of LM based on ingested lactose dose (OR = 1.122; 95% CI = 0.929-1.356) and test type (OR = 1.156; 95% CI = 0.985-1.356). However, significantly more IBS patients had objective LI (OR = 2.521; 95% CI = 1.280-4.965).

Conclusions and inferences: Lactose intolerance, but not LM is more frequent among patients with IBS compared to HCs. According to our results, IBS among other functional bowel disorders is a possible contributing factor of LI in people with LM.

Keywords: irritable bowel syndrome; lactose intolerance; lactose maldigestion.

Conflict of interest statement

No competing interests declared.

© 2018 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
PRISMA‐flowchart of the systematic literature search. IBS: irritable bowel syndrome; SIBO: small intestinal bacterial overgrowth
Figure 2
Figure 2
The difference of LM between IBS and HCs, based on the ingested lactose dose (10‐18 g, 20‐25 g, 40‐50 g). There was no significant difference either overall, or in the subgroups. HC, healthy controls; IBS, irritable bowel syndrome; LM, lactose maldigestion
Figure 3
Figure 3
The difference of LM between IBS and HCs, based on the diagnostic method (LBT, LTT, genetic test). There was no significant difference either overall, or in the subgroups. HC, healthy controls; IBS, irritable bowel syndrome; LBT, lactose breath test; LM, lactose maldigestion; LTT, lactose tolerance test
Figure 4
Figure 4
The difference of LM between IBS and HCs, based on the lactose dose and diagnostic method. LM was significantly more frequent in IBS only at the LBT with the highest lactose dose (40‐50 g). HC, healthy controls; IBS, irritable bowel syndrome; LBT, lactose breath test; LM, lactose maldigestion
Figure 5
Figure 5
The difference of subjective (self‐reported) LI between IBS and HCs. Subjective LI was significantly (P = 0.001) more frequent in IBS compared to the control group. HC, healthy controls; IBS, irritable bowel syndrome; LI, lactose intolerance
Figure 6
Figure 6
The difference of objective LI between IBS and HCs. Objective LI was significantly (P = 0.008) more frequent in IBS compared to the control group. HC, healthy controls; IBS, irritable bowel syndrome; LI, lactose intolerance

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