Lactulose/mannitol test: an ideal screen for celiac disease

Gastroenterology. 1989 Jan;96(1):79-85. doi: 10.1016/0016-5085(89)90767-1.


A lactulose/mannitol (La/Ma) test was compared with a standard cellobiose/mannitol test (Ce/Ma) in 17 patients with newly diagnosed celiac disease and 12 healthy controls. The mean La/Ma test was 0.163 (SEM 0.076) in celiacs and 0.016 (SEM 0.002) in controls. The mean Ce/Ma test was 0.132 (SEM 0.024) in celiacs and 0.014 (SEM 0.002) in controls (p less than 0.001). There is no significant difference between the new La/Ma test and the Ce/Ma test. Eighty-two patients referred to a general gastroenterology clinic with symptoms or signs of celiac disease performed a La/Ma test. A jejunal biopsy was indicated in 44 of these. In this selected group the sensitivity was 89%, specificity 54%, and negative predictive value of 95%. The La/Ma test fulfills the criteria of a screening test; it is sensitive, of low cost, and simple to perform, and it has the advantage of a simple enzyme assay and does not cause diarrhea in patients with hypolactasia. It can, therefore, be used in screening large patient populations.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Celiac Disease / diagnosis*
  • Celiac Disease / pathology
  • Celiac Disease / urine
  • Cellobiose / urine
  • Disaccharides*
  • Female
  • Humans
  • Jejunum / pathology
  • Lactulose* / urine
  • Male
  • Mannitol* / urine
  • Middle Aged
  • Predictive Value of Tests


  • Disaccharides
  • Cellobiose
  • Mannitol
  • Lactulose