Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study

Azcona, Oihana Martínez; Moreno-Álvarez, Ana; Seoane-Pillado, Teresa; Niño-Grueiro, Inés; Ramiro-Comesaña, Ana; Menéndez-Riera, María; Pérez-Domínguez, Marta; Solar-Boga, Alfonso; Leis, Rosaura

doi:10.1007/s00431-019-03418-4

Cited by 11 publications

(19 citation statements)

References 30 publications

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“…Although carbohydrate malabsorption is frequently detected in children, which corresponds to our findings, symptom relief has not been achieved by elimination of the respective carbohydrate in several randomized controlled trials [29,37]. We report lower dietary response rates to lactose-free or fructose-restricted diet (24% and 18%, respectively) than other studies [8,10,21,28,30,35,38]. However, the best dietary response rates (81-95%) have been reported in patients diagnosed with lactose or fructose intolerance [9,30,38].…”

Section: Discussionsupporting

confidence: 76%

“…However, the best dietary response rates (81-95%) have been reported in patients diagnosed with lactose or fructose intolerance [9,30,38]. In our study, dietary response was defined as relief in abdominal pain, whereas other studies rated abdominal pain reduction as a response [8,35]. In addition, several studies assessed the dietary response after one or two months [10,35].…”

Section: Discussionmentioning

confidence: 90%

“…In our study, dietary response was defined as relief in abdominal pain, whereas other studies rated abdominal pain reduction as a response [8,35]. In addition, several studies assessed the dietary response after one or two months [10,35]. Thus, a later assessment of dietary response may also influence the response rate as a decrease in the impact of diet has been reported [30].…”

Section: Discussionmentioning

confidence: 99%

“…We administered a solution of 2 g of lactose per kilogram body weight up to a maximum of 50 g, which is within the upper dose range of 0.5 to 2 g/kg up to an absolute amount of 25 or 50 g used in pediatric studies ( Supplementary Table S3) [11,22,27,[29][30][31][32]. In the absence of a gold standard for fructose H 2 BT, we administered a fructose solution of 1 g per kilogram body weight up to a maximum of 25 g, which is within the dose range of 0.5 to 2 g/kg up to a maximum of 10 to 50 g used in recent pediatric studies ( Supplementary Table S4) [9,11,21,29,[33][34][35]. Of note, increasing the fructose load up to 1.4 g/kg body weight on average resulted in increases in hydrogen production and H 2 BT positivity [9].…”

Section: Discussionmentioning

confidence: 99%

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Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

et al. 2019

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Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7–12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

et al. 2019

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“…A study of national HFCS production and diabetes prevalence was conducted by Goran et al in 2013. (67) It was found that there is a twenty percent increase in the prevalence of typetwo diabetes in HFCS-producing countries, with a p-value = 0.013. Although the values in the paper are skewed by the significantly higher than average prevalence of type 2 diabetes in the USA (this study examined type 2 diabetes), it could be argued that due to the estimates of HFCS production, that fructose malabsorption prevalence may follow a similar trend.…”

Section: Effect Of Diet Relating To Fructose Malabsorptionmentioning

confidence: 99%

Fructose malabsorption: causes, diagnosis and treatment

et al. 2021

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This review intends to act as an overview of Fructose Malabsorption (FM) and its role in the aetiology of diseases including, but not limited to, Irritable Bowel Syndrome (IBS) and Infantile colic and the relationship between fructose absorption and the propagation of some cancers. IBS results in a variety of symptoms including stomach pains, cramps and bloating. Patients can be categorised into two groups, depending on whether the patients’ experiences either constipation (IBS-C) or diarrhoea (IBS-D). Fructose Malabsorption has been proposed as a potential cause of IBS-D and other diseases, such as infantile colic. However, our knowledge of FM is limited by our understanding of the biochemistry related to the absorption of fructose in the small intestine and FM’s relationship with Small Intestinal Bacteria Overgrowth (SIBO). It is important to consider the dietary effects on FM and most importantly, the quantity of excess free fructose consumed. The diagnosis of FM is difficult and often requires indirect means that may result in false positives. Current treatments of FM include dietary intervention, such as low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diets and enzymatic treatments, such as the use of xylose isomerase. More research is needed to accurate diagnose and effectively treat FM. This review is designed with the goal of providing a detailed outline of the issues regarding the causes, diagnosis and treatment of FM.

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Assessment of dietary interventions including low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet as management for fructose intolerance

Lin,

Batiuk,

Hunter

2024

J. pediatr. gastroenterol. nutr.

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ObjectivesAbdominal pain remains one of the most common referral reasons to pediatric gastroenterology. Dietary intolerances are often considered but due to various factors are hardly pursued. We observed that diet review in large number of children with abdominal pain was high in sugary foods which led to food intolerance investigation and dietary intervention.MethodsA retrospective review was conducted of patients presenting with abdominal pain, diarrhea, or vomiting and negative GI evaluation, who underwent fructose breath testing. Patients younger than 20 years old who were seen between June 1, 2018 and March 1, 2021 were included. Statistical analysis was performed in R.ResultsThere were 110 pediatric patients during the study period who underwent fructose breath testing, with 31% male and 69% female. The average age was 12.14 ± 4.01 years, and the average BMI was 21.21 ± 6.12. Abdominal pain was the most common presenting symptom (74.5%) followed by diarrhea and vomiting. Seventy‐seven patients (70%) had a positive fructose breath test and were diagnosed with dietary intolerance to fructose. The 56 (67.5%) of those patients experienced symptoms during the breath test. Forty‐three patients improved with dietary intervention. Twenty‐seven on low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet and 16 on other diets.ConclusionsBased on analysis of our cohort of children with abdominal pain and high incidence of fructose intolerance as well as improvement in symptoms, following dietary changes, this condition should be considered and treated. Further investigation is needed to improve diagnostic testing but also into understanding mechanisms behind symptom presentation in this population.

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Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study

Cited by 11 publications

References 30 publications

Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

Fructose malabsorption: causes, diagnosis and treatment

Assessment of dietary interventions including low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet as management for fructose intolerance

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