The impact of anxiety on lactose intolerance symptoms

Veronica Ojetti, Tortora Annalisa, Ianiro Gianluca, Bertucci Flavio, Ferrarese Daniele, Buccelletti Francesco, Zuccala’ Giuseppe, Gasbarrini Antonio

Department of Emergency Medicine, Catholic University, Rome, Italy.
Department of Internal Medicine and Gastroenterology, Catholic University, Rome, Italy.

DOI: 10.4236/ojgas.2013.32015                

Abstract

BACKGROUND Lactose malabsorption is variably associated with lactose intolerance (LI). The determinants of symptom onset have not yet been completely identified. Visceral sensitivity may play a role in the pathogenesis of functional symptoms; an increasing bulk of clinical and research data suggests the importance of the brain-gut interaction in intestinal bowel syndrome. AIM: To assess the impact of anxiety on LI symptoms, and the correlation between gas production during Lactose Breath test (LBT) and the intensity of gastrointestinal symptoms (GI) in anxious (A) and non-anxious (NA) patients. METHODS: LBT was carried out in 104 consecutive participants referred to our Gastroenterology Unit. GI symptoms were evaluated using the visual analogue scale (VAS: 0-10) throughout the LBT. All patients completed the HADS to determine anxiety. RESULTS LBT was positive in 70/104 (67%) participants; 49/ 104 (47%) showed significant anxiety symptoms (>10 items). In A subjects we did not find any significant correlation between gas levels and abdominal LI symptoms scores throughout the LBT. A subject showed higher scores for all LI symptoms as compared with other participants, independently of LBT results. NA pts with positive LBT showed higher scores for all LI symptoms, as compared to negative subjects. LIMITATIONS: The predominant gender is female but it is in agreement with literature data that show a preponderance of IBS in women. CONCLUSIONS: A status significantly influences the severity of all LI symptoms and does not strictly correlate with lactase deficiency. Conversely, among NA subjects LI symptoms increase along with H₂ production. Anxiety seems to be a confounding factor in IBS pts.

Keywords

Lactose Intolerance; Anxiety; H2 Breath Test

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Swagerty, D.L., Walling, A.D. and Klein, R.M. (2002) Lactose intolerance. American Family Physician, 65, 1845-1850.
[2]	Sahi, T. (1994) Genetics and epidemiology of adult type hypolactasia. Scandinavian Journal of Gastroenterology, 29, 7-20. doi:10.3109/00365529409091740
[3]	Vuorisalo, T., Arjamaa, O., Vasemagi, A., Taavitsainem, J.P. and Tourunen, A. (2012) Saloniemi. Perspectives in Biology and Medicine, 55, 163-174. doi:10.1353/pbm.2012.0016
[4]	Levitt, M.D. (1969) Production and excretion of hydrogen gas in man. New England Journal of Medicine, 281, 122-127. doi:10.1056/NEJM196907172810303
[5]	Levitt, M.D. and Donaldson, R.M. (1970) Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. Journal of Laboratory and Clinical Medicine, 75, 937-945.
[6]	Gudmand-Hoyer, E. (1994) The clinical significance of disaccharide maldigestion. American Journal of Clinical Nutrition, 59, 735S-741S.
[7]	Calrk, G., Quigley, E.M., Cryan, J.F. and Dinan, T.G. (2009) Irritable bowel syndrome: Towards biomarker identification. Trends in Molecular Medicine, 15, 478-489. doi:10.1016/j.molmed.2009.08.001
[8]	Konturek, P.C., Brzozowski, T. and Konturek, S.J. (2011) Stress and the gut: Pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology, 62, 591-599.
[9]	Tosic-Golubovic, S., Miljkovic, S., Nagorni, A., Lazarevic, D. and Nikolic, G. (2010) Irritable bowel syndrome, anxiety, depression and personality characteristics. Psychiatria Danubina, 22, 418-424.
[10]	Cho, H.S., Park, J.M., Lim, C.H., Cho, Y.K., Lee, I.S., Kim, S.W., Choi, M.G., Chung, I.S. and Chung, Y.K. (2011) Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut and Liver, 5, 29-36.
[11]	Jones, M., Koloski, N., Boyce, P. and Talley, N.J. (2011) Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS. Journal of Psychosomatic Research, 70, 278-285.
[12]	Strocchi, A., Corazza, G.R., Anania, C., Benati, G., Malservisi, S., Cherchi, M.V., et al. (1997) Quality control study of H2 breath testing for the diagnosis of carbohydrate malabsorption in Italy. The “Tenue Club” Group. Italian journal of gastroenterology and hepatology, 29, 122-127.
[13]	Hartono, J.L., Mahadeva, S. and Goh, K.-L. (2012) Anxiety and depression in various functional gastrointestinal disorders: Do differences exist? Journal of Digestive Diseases, 13, 252-257. doi:10.1111/j.1751-2980.2012.00581.x
[14]	Addolorato, G., Marsigli, L., Capristo, E., Caputo, F., Dall’Aglio, C. and Baudanza, P. (1998) Anxiety and depression: A common feature of health care seeking patients with irritable bowel syndrome and food allergy. Hepatogastroenterology, 45, 1559-1564.
[15]	Erminia, R., Ilaria, B., Tiziana, M., Silvia, P., Antonio, N., Pierpaolo, D. and Loris, B. (2011) HRQoL questionnaire evaluation in lactose intolerant patients with adverse reactions to foods. Internal and Emergency Medicine.
[16]	Gasbarrini, A., et al. (2009) Methodology and indications of H2-breath testing in gastrointestinal diseases: The Rome Consensus Conference. Aliment Pharmacol Ther, 29, 1-49.