Post-infectious lactose intolerance and irritable bowel syndrome

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Clinical Presentation

  • Diarrheal illness followed by persistent diarrhea despite appropriate treatment
  • Can occur following dysentery or C. difficile infection

Management

  • Week one: lactose-free diet
    • Avoid all lactose-containing foods, including milk and milk products like cheese, cream, yoghurt, and ice creams
    • If symptoms significantly improve, continue the lactose-free diet
    • If symptoms do not significantly improve, proceed to week two
  • Week two: high-fibre diet
    • Start metamucil (psyllium fibre) 1-2 tablespoons in a glass of juice or water daily, followed by another glass of juice or water
      • May cause bloating and gas (which improve), or rare allergy
      • Use sugar-free metamucil
    • Start PEG 3350 1-2 tablespoons once daily (can be mixed with metamucil)
      • May cause bloating and gas
    • Consider avoiding alcohol, caffeine, spicy food, stress, and gas-producing foods (broccoli, cabbage, Brussels sprouts, beans, etc.) which can trigger or worsen irritable bowel syndrome