Fructose malabsorption and fructan malabsorption are associated in patients with irritable bowel syndrome

Abstract

Background Food malabsorption and intolerance is implicated in gastrointestinal symptoms among patients with irritable bowel syndrome (IBS). Key triggers include fructose and fructan. Prior studies examined fructose and fructan malabsorption separately in IBS patients. None have concurrently assessed both within the same patient group. We aimed to investigate the association between fructose and fructan malabsorption in the same patients with IBS using hydrogen breath testing (HBT). Methods We retrospectively identified patients with IBS who underwent fructose and fructan HBTs and abstracted their results from the electronic medical record. Fructose and fructan HBTs were performed by administering a 25 g fructose solution or 10 g fructan solution, followed by breath hydrogen readings every 30 min for 3 h. Patients were positive for fructose or fructan malabsorption if breath hydrogen levels exceeded 20 ppm. Results Of 186 IBS patients, 71 (38.2%) were positive for fructose malabsorption and 91 (48.9%) were positive for fructan malabsorption. Of these patients, 42 (22.6%) were positive for fructose malabsorption and fructan malabsorption. Positive fructose HBT readings were significantly associated with positive fructan HBT readings (p = 0.0283). Patients positive for fructose malabsorption or fructan malabsorption had 1.951 times higher odds of testing positive for the other carbohydrate. Conclusions Our results reveal a clinically significant association between fructose malabsorption and fructan malabsorption in patients with IBS. Fructan malabsorption should be assessed in patients with fructose malabsorption, and vice versa. Further studies are required to identify the mechanisms underlying our findings.

Gastrointestinal Symptoms and Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Sources in Schoolchildren—A Pilot Study

“…Chumpitazi et al found that fructans exacerbated symptoms in a selected group of children with IBS [29]. This was also reported in studies in adults with IBS [30,31]. Interestingly, our study conducted on a population of children who were not previously diagnosed with IBS, also found that fructan-rich vegetables, particularly onions and garlic, were prevalent food items associated with GI symptoms-in particular, abdominal pain, nausea, and flatulence.…”