Cancer chemotherapy-induced lactose malabsorption.pdfVIP

Cancer Chemotherapy-Induced Lactose Malabsorption in Children JEFFREY S. HYAMS, MD,’ CAROL L. BATRUS, RD, MS. RICHARD J. GRAND, MD, AND STEPHEN E. SALLAN. MD To determine whether lactose malabsorption can be induced in children receiving cancer chemotherapy, lactose breath hydrogen tests (LBHT) were performed on 27 patients (ages 2 months to 16 10/12 years, mean 4 3/12 years) with neoplastic disease. Nine patients had an LBHT before their first course of chemotherapy and then 7-26 days afterwards. Eighteen other patients, less than 5 years old and presumed by virtue of age to be normal lactose absorbers, had an LBHT 7-24 days after their last course of chemotherapy. All nine in the first group had a normal LBHT before chemotherapy, and three had an abnormal LBHT 7-21 days later. Six of eighteen patients in the second group had an abnormal LBHT. Of the nine patients with an abnormal LBHT, six had a history of diarrhea associated with chemotherapy. These findings have important implications for children receiving cancer chemotherapy. High-calorie, milk-containing solutions used in nutritional support may precipitate cramps and diarrhea in some of these patients. A therapeutic trial of a low lactose diet in children in whom diarrhea develops during chemotherapy may be indicated. Cancer 49:646-650, 1982. H E GASTROINTESTINAL SIDE EFFECTS of combina- T tion chemotherapy in patients being treated for neoplastic disease result in marked morbidity. Partic- ularly common is the diarrhea that occurs after intensive treatment with certain antimetabolites (meth- otrexate, 5-Ruorouracil, Cytosine Arabinoside, 6- mercaptopurine) and tumoricidal antibiotics (Adria- mycin, actinomycin D).’ Although previous work has demonstrated small intestinal and colonic epithelial changes following treatment with cytostatic agents,*-’ the pathogenesis of the diarrhea is unclear. Craft el ~ 1 . ~ reported impaired absorption of D-xylose in a group of children receivi