Intestinal Lactase Deficiency in Ulcerative Colitis and Regional Ileitis

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Abstract
The mechanism of milk intolerance was investigated in 2 patients, 1 of whom had chronic ulcerative colitis and the other regional ileitis. Milk had caused increased diarrhea in both patients. Little or no increase of blood glucose concentration occurred after lactose was administered orally (50 g/square m of body surface) or intraduodenally (30 g in 300 ml over 30 minutes). Other disaccharides, glucose, d-xylose and vitamin B12 were normally absorbed. The malabsorbed lactose caused the excretion of 860 to 2800 mg/d of lactic acid in the feces (normal = 32.4 [plus or minus] 22.0). Significant steatorrhea occurred after intraduodenal lactose in 1 patient. Neither patient had symptoms, steatorrhea or increased fecal lactic acid excretion when fed a diet free of milk or milk products. Furthermore, milk constituents, other than lactose, when given alone caused no symptoms or evidence of mal-absorption. The jejunal mucosa of 1 patient was histologically normal but showed markedly deficient lactase activity on 2 occasions. Maltase and invertase were present in normal amounts. Milk intolerance in these patients is caused by an isolated intestinal lactase deficiency and not by sensitivity to cow''s milk protein; and that the malabsorption of lactose can cause significant steatorrhea.

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