A 13CO2 breath test using naturally enriched 13C-lactose as a substrate was performed in 47 patients with chronic abdominal pain or chronic diarrhea, taken from a population with a low prevalence of primary acquired lactase deficiency. The cumulative 13CO2 excretion 4 hours after 13C-lactose intake was compared with the H2 breath excretion and with jejunal lactase activity. A physiologically significant relation was found between the cumulative 13CO2 excretion (at 4 hours) and lactase activity, 14.5% 13CO2 excretion being the best cutoff point for discrimination between patients with low and normal lactase activity. The 13CO2 breath test was found to be more sensitive (0.84 versus 0.68) and more specific (0.96 versus 0.89) than the H2 breath test in detecting low jejunal lactase activity. Concordant results of both breath tests performed simultaneously give a reliable picture of the lactose absorption status of the patient. Discordance in results of 13CO2 and H2 lactose breath tests, if not explained by history, indicates in which patients a jejunal biopsy should be performed. If lactase activity and morphology of the biopsy are normal, other causes of discordance must be investigated.