BlueCross BlueShield of Tennessee Medical Policy Manual

Genetic Testing for Lactase Insufficiency

Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018

DESCRIPTION

Genetic testing of adults with suspected lactase insufficiency is proposed as an alternative to current diagnostic practices which include hydrogen breath test, lactose tolerance blood test, and intestinal biopsy. Targeted genetic testing for the -13910C>T variant is to inform a decision whether to undergo one of these diagnostic tests.

Lactase is an enzyme necessary for the digestion of the sugar lactose found in dairy products. An insufficiency of lactase results in the malabsorption of lactose which may lead to symptoms of lactose intolerance such as abdominal pain, bloating, diarrhea, and increased flatulence. Dietary restriction as the primary treatment is adequate in most circumstances. For the majority of individuals who do not achieve symptom control following dietary modifications, further diagnostic testing is indicated for the presence of other conditions that might cause symptoms similar to lactase deficiency.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

Meaningful improvements in health outcomes through the use of genotyping for lactase insufficiency have not been demonstrated.

SOURCES  

BlueCross BlueShield Association. Evidence Positioning System. (6:2021). Genetic testing for lactase insufficiency (2.04.94). Retrieved July 15, 2021 from https://www.evidencepositioningsystem/. (39 articles and/or guidelines reviewed)

Enko, D., Rezanka, E., Stolba, R., & Halwachs-Baumann, G. (2014). Lactose malabsorption testing in daily clinical practice: a critical retrospective analysis and comparison of the hydrogen/methane breast test and genetic test (C/T-13910 polymorphism) results. Gastroenterology Research and Practice, 2014, Article ID 464382. (Level 4 evidence)

Mattar, R., Basile-Filho, A., Kemp, R., & Santos, J.S. (2013). Comparison of quick lactose intolerance test in duodenal biopsies of dyspeptic patients with single nucleotide polymorphism LCT-13910C>T associated with primary hypolactasia/lactase-persistence. Acta Cirurgica Brasileira, 28 Suppl1, 77-82. Abstract retrieved February 20, 2018 from PubMed database.

Misselwitz, B., Pohl, D., Frühauf, H., Fried, M., Vavricka, S., & Fox, N. (2013). Lactose, malabsorption, and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterology Journal, 1 (3), 151-159. (Level 5 evidence)

Santonocito, C., Scapaticci, M., Guarino, D., Annicchiarico, E.B., Lisci, R., Penitente, R., et al. (2015). Lactose intolerance genetic testing: is it useful as routine screening? Results on 1426 south-central Italy patients. Clinica Chemica Acta, 439, 14-17. Abstract retrieved December 12, 2018 from PubMed database.

ORIGINAL EFFECTIVE DATE:  12/14/2013

MOST RECENT REVIEW DATE:  9/9/2021

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