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Visceral hypersensitivity and intolerance symptoms in
Visceral hypersensitivity and intolerance symptoms in
lactose malabsorption
M. DI STEFANO, E. MICELI, S. MAZZOCCHI, P. TANA, F. MORONI G. R. CORAZZA
Department of Medicine, IRCCS S.Matteo Hospital, University of Pavia, Pavia, Italy
Abstract Lactose malabsorption is not always associ-
ated with intolerance symptoms. The factors respon-
sible for symptom onset are not yet completely
known. As differences in visceral sensitivity may play
a role in the pathogenesis of functional symptoms, we
evaluated whether an alteration of visceral sensitivity
is present in subjects with lactose intolerance. Thirty
subjects, recruited regardless of whether they were
aware of their capacity to absorb lactose, underwent
an evaluation of intestinal hydrogen production
capacity by lactulose breath test, followed by an
evaluation of lactose absorption by hydrogen breath
test after lactose administration and subsequently an
evaluation of recto-sigmoid sensitivity threshold dur-
ing fasting and after lactulose administration, to
ascertain whether fermentation modifies intestinal
sensitivity. The role of differences in gastrointestinal
transit was excluded by gastric emptying and mouth-
to-caecum transit time by 13C-octanoic and lactulose
breath tests. Lactulose administration induced a sig-
nificant reduction of discomfort threshold in subjects
with lactose intolerance but not in malabsorbers
without intolerance symptoms or in subjects with
normal lactose absorption. Perception threshold
showed no changes after lactulose administration.
Severity of symptoms in intolerant subjects was sig-
nificantly correlated with the reduction of discomfort
thresholds. Visceral hypersensitivity should be con-
sidered in the induction of intolerance symptoms in
subjects with lactose malabsorption.
Keywords barostat, diagnosis, lactose intolerance,
lactose malabsorption, visceral sensitivity.
INTRODUCTION
Lactose malabsorption is a widespread condition
throughout the world caused by a genetically deter-
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