Lactose Intolerance in Childhood Coeliac Disease

There is dispute about the frequency and importance of disaccharide intolerance in childhood coeliac disease. Arthur and his co-workers (1966) considered that intolerance to disaccharides, especially lactose, was common, whereas Anderson and her colleagues (1966) thought that it occurred only rarely. Arthur et al. recommended the routine exclusion from the diet of lactose and sucrose as well as gluten in the early months of treatment of all coeliac children, because they were unable to predict those children who would fail to improve after gluten withdrawal alone. Anderson et al. considered that the presence of raised quantities of sugars in the faeces was an essential factor in the diagnosis of disaccharide intolerance (Kerry and Anderson, 1964; Anderson et al., 1966). Using this criterion, they found that children with coeliac disease were only rarely intolerant oflactose or sucrose. Furthermore, they questioned the diagnosis of coeliac disease in the case reported in detail by Arthur et al., and suggested that the patient might have had a 'secondary disaccharidase deficiency', a separate condition that had been described previously (Burke, Kerry, and Anderson, 1965; Anderson, 1966). Laws and Neale (1966) described the use of a lactose-barium sulphate mixture in screening for primary intestinal lactase deficiency with lactose intolerance. However, in a small series of adult patients with coeliac disease, they were unable to diagnose lactose intolerance by this technique (Laws, Spencer, and Neale, 1967). The present study was designed to investigate the incidence and importance of lactose intolerance in children with coeliac disease using conventional parameters. At the same time we have assessed the worth of a modified lactose-barium examination in detecting secondary lactose intolerance.