Do lactose-free feeds reduce diarrhoea duration in infants and young children with acute gastroenteritis?
Damage to the small intestinal mucosa by pathogens causing acute gastroenteritis may result in temporary lactose intolerance. In the child with prolonged watery diarrhoea (> 7 days) associated with perianal excoriation, carbohydrate malabsorption should be excluded by testing the stool for reducing substances and, if confirmed, lactose-free feeds may be indicated. But should lactose-free feeds be used routinely in the initial management of gastroenteritis to reduce the duration of symptoms? In a systematic review33 of studies comparing lactose-free and lactose-containing diets for children with diarrhoea and mild to moderate dehydration, lactose-free diets appeared to decrease the duration of diarrhoea in some subgroups of children. The significant heterogeneity between these studies brings into question the validity of pooling these data. Of five RCTs published subsequently,32 three small studies reported no difference in diarrhoea duration between groups. In the two larger trials chi
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