Food Intolerance Flashcards

1
Q

Define food intolerances

A

Non-immune adverse reactions to food and/or food additives that are distinct from food allergy

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2
Q

Which food intolerances are most common

A

Lactose (most common)
Wheat

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3
Q

What is the aetiology of lactose intolerance

A

Lactase enzyme not expressed on the microvilli of the intestine → lactose cannot be broken down into glucose + galactose → lactose ferments in the gut → waste gas
May be primary, congenital, secondary/acquired hypolactasia (gastroenteritis, giardiasis, coeliac disease)

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4
Q

What are the risk factors for food intolerances

A

Recent gastroenteritis (post gastroenteritis syndrome)
Irritable bowel syndrome (Crohn’s)
Family history (congenital lactose intolerance)
Coeliac disease

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5
Q

What are the symptoms of food intolerance

A

Symptoms arise with the consumption of lactose-containing products - Often a delay in onset (minutes to hours) and prolonged symptomatic phase
Often presents later in life than CMPA

GI symptoms: bloating, abdominal pain, vomiting, diarrhoea, constipation
Foul smelling ‘yeasty’ stool: Explosive, bulky, frothy, watery
Headache
Fatigue
Musculoskeletal symptoms
Failure to thrive, faltering growth

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6
Q

What are the signs of food intolerance on examination

A

Weight and height
Obs
Abdominal: Abdominal tenderness, Abdominal distension

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7
Q

What are the differentials for food intolerances

A

Coeliac disease
Sucrase-isomaltase deficiency
CMPA
Giardiasis
Irritable bowel syndrome
Tropical sprue

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8
Q

What investigations should be done for lactose intolerance

A

Clinical diagnosis → 2 week trial of dietary lactose elimination

If inconclusive:
Lactose hydrogen breath test
Stool for reducing substances and pH: +ve with low pH
FBC (anaemia from secondary lactase deficiency from coeliac)
Small bowel biopsy (persistent symptoms)
Lactose intolerance test: measures serum glucose after lactose administration

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9
Q

What is the management for lactose intolerances

A
  1. 2-week dietary lactose elimination trial followed by reintroduction
    → Resolution of symptoms followed by resumption after lactose is re-introduced is diagnostic

Dairy-free exclusion diet + referral to dietician
± Lactase supplements (although easily denatured by the stomach)
± lactase-treated dairy products
± calcium supplements

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10
Q

What are the complications of lactose intolerance

A

Osteoporosis
Rickets
Malnutrition
Faltering growth

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11
Q

What is the prognosis for lactose intolerance

A

Will resolve after several months of the dairy-free diet, when lactase starts to be expressed again
Excellent prognosis
Persistent symptoms in a small number of patients is due to ongoing inadvertent lactose exposure, IBS, or poorly controlled underlying disorders
Treatment is lifelong and adherence can be an issue, especially in children

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