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Development, Validation, and Applicability of a Symptoms Questionnaire for Lactose Malabsorption Screening

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Abstract

Lactase deficiency has a high prevalence worldwide. Thus, a valid symptom scale would be a useful tool for identifying patients with lactose malabsorption. Objective To develop, validate, and apply a symptoms questionnaire on lactose malabsorption to identify lactose malabsorbers diagnosed with the gold-standard hydrogen breath test. Methods In the first part of the study, 292 patients completed a questionnaire at the end of a 50-g lactose breath test. The questionnaire included five items (diarrhea, abdominal cramping, vomiting, audible bowel sounds, and flatulence or gas) scored on a 10-cm visual analogue scale. In the second part of the study, 171 patients completed the questionnaire twice: first, according to their opinion when consuming dairy products at home and second, after a 50-g lactose breath test. Patients were grouped as absorbers or malabsorbers according to the result of the breath test. Results Diarrhea, abdominal cramping, and flatulence were scored significantly higher in malabsorbers than in absorbers. Total score of the symptomatic questionnaire was significantly higher in malabsorbers (17.5 versus 3.0, P < 0.01). According to receiver operator characteristics (ROC) analysis, the most discriminant cut-off of the total score to identify lactose malabsorption was 6.5 (sensitivity 0.75, specificity 0.67). In 58 malabsorbers the effect size of the questionnaire to determine sensitivity to change was 1.32. In the second part of the study, scoring of the home questionnaire was higher than after the lactose-breath test. The lactose malabsorbers rate was higher according to the home questionnaire than after the lactose breath test (72% versus 52%). The home questionnaire had excellent sensitivity (0.82) but low specificity (0.35). Conclusion We developed and validated a five-item symptoms questionnaire for lactose malabsorption. This is a valid test that permits patients with a total score lower than 7 to be excluded from future studies.

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Acknowledgments

We thank Miss. Christine O’Hara for valuable contributions to the English revision of this manuscript. Ciberehd is funded by the Instituto de Salud Carlos III, Spain. This work was supported in part by grants from the Generalitat de Catalunya (RE: 2001SGR00389) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd, Spain).

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Authors and Affiliations

  1. Digestive System Research Unit, Hospital Universitari Vall d’Hebron, Pso. Vall d’Hebron 119, Barcelona, 08035, Spain

    Francesc Casellas, E. Varela, A. Aparici, M. Casaus & P. Rodríguez

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  1. Francesc Casellas
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  2. E. Varela
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  3. A. Aparici
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  4. M. Casaus
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  5. P. Rodríguez
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Correspondence to Francesc Casellas.

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Casellas, F., Varela, E., Aparici, A. et al. Development, Validation, and Applicability of a Symptoms Questionnaire for Lactose Malabsorption Screening. Dig Dis Sci 54, 1059–1065 (2009). https://doi.org/10.1007/s10620-008-0443-3

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  • DOI: https://doi.org/10.1007/s10620-008-0443-3

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