{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:21:27Z","timestamp":1791397287450,"version":"4.3.3"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lactose malabsorption is commonly assumed to cause gastrointestinal discomfort, but symptoms often persist despite lactose restriction or enzyme supplementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to assess symptoms following lactose ingestion, its relationship with malabsorption, and its association with fructose sensitivity and disorders of the gut\u2010brain interactions (DGBIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In 753 consecutive patients with DGBIs, we performed hydrogen breath tests and used the validated adult Carbohydrate Perception Questionnaire (aCPQ) to assess lactose\u2010induced symptoms. Lactose malabsorption (LM+) was defined as a hydrogen increase of &gt;\u200920\u2009ppm. Lactose induced burdensome symptoms (LS+) were defined by a visual analogue scale (VAS) increase of &gt;\u200920\u2009mm. Fructose sensitivity was assessed in 547 patients using the same protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LM+ was observed in 40.9% of patients, while 55.4% reported LS+. Interestingly, 45.3% of symptomatic patients had no lactose malabsorption (LM\u2212) and 26.0% of malabsorbers had no symptoms (LS\u2212). LS+ were significantly more likely to exhibit fructose sensitivity (45.2% vs. 24.2% in LS\u2212,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). DGBIs were similarly distributed in LS+ patients with and without malabsorption. Functional dyspepsia and irritable bowel syndrome were significantly more frequent in LS+, irrespective of whether lactose was malabsorbed or not, than in those without lactose\u2010induced symptoms (with or without malabsorption).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lactose malabsorption alone is an inadequate predictor of the occurrence of symptoms, emphasizing the need for comprehensive symptom assessment beyond breath test results. This has important implications for the selection of appropriate therapies. The association between lactose and fructose sensitivity suggests a role for visceral hypersensitivity and overlapping mechanisms in symptom development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70167","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T19:43:23Z","timestamp":1758138203000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Beyond Malabsorption: The Need for Symptom\u2010Based Assessment in Suspected Lactose Intolerance. Lessons From a Test\u2010Specific Symptom Assessment"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2452-1201","authenticated-orcid":false,"given":"Johann","family":"Hammer","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Internal Medicine 3 Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8683-4951","authenticated-orcid":false,"given":"Heinz F.","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Medical University Graz  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-017-0558-9"},{"key":"e_1_2_11_3_1","first-page":"973","article-title":"Hypolactasia and Lactase Persistence: Population Genetics, Evolution, and Consequences for Human Health","volume":"54","author":"Sahi T.","year":"1994","journal-title":"American Journal of Human Genetics"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-318404"},{"key":"e_1_2_11_5_1","first-page":"9","article-title":"Mistakes in the Management of Carbohydrate Intolerance and How to Avoid Them","volume":"19","author":"Hammer H. 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