Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double‐blinded testing

Gijsbers, Carolien; Kneepkens, C. M. F.; Büller, Hans A.

doi:10.1111/j.1651-2227.2012.02721.x

Cited by 46 publications

(55 citation statements)

References 32 publications

(41 reference statements)

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“…In pediatric field there is no agreement on the methodological aspects of HBT even though the modifications of the test meal, the substrate dose, the test performance and the data analysis can have a marked influence on the test results. Studies in children have included lactose doses ranging from 0.5 to 2.0 g/kg, up to an absolute/maximum dose of 25–50 g [1,5,14]. No gold standard is available for the diagnosis of other sugar malabsorption and fructose as well as sorbitol HBT are therefore not recommended in clinical practice [5].…”

Section: Discussionmentioning

confidence: 99%

“…Patients received lactose (AppliChem, Darmstadt, Germany) at a dose of 1 g/kg body weight (20% water solution; maximum dose 50 g), fructose (AppliChem, Darmstadt, Germany) at a dose of 0.5 g/kg body weight (10% water solution; maximum dose 25 g), or sorbitol (AppliChem, Darmstadt, Germany) at a dose of 0.2 g/kg body weight (10% water solution; maximum dose 10 g) in a drink of 6 ml/kg (maximum volume 300 ml) [5,11-14]. Patients could have more than one test, but only at different days.…”

Section: Methodsmentioning

confidence: 99%

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Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

et al. 2014

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BackgroundHydrogen breath tests are noninvasive procedures frequently applied in the diagnostic workup of functional gastrointestinal disorders. Here, we review hydrogen breath test results and the occurrence of lactose, fructose and sorbitol malabsorption in pediatric patients; and determine the significance of the findings and the outcome of patients with carbohydrate malabsorption.MethodsWe included 206 children (88 male, 118 female, median age 10.7 years, range 3–18 years) with a total of 449 hydrogen breath tests (lactose, n = 161; fructose, n = 142; sorbitol, n = 146) into a retrospective analysis. Apart from test results, we documented symptoms, the therapeutic consequences of the test, the outcome and the overall satisfaction of the patients and families.ResultsIn total, 204 (46%) of all breath tests were positive. Long-term follow-up data could be collected from 118 patients. Of 79 patients (67%) who were put on a diet reduced in lactose, fructose and/or sorbitol, the majority (92%, n = 73) reported the diet to be strict and only 13% (n = 10) had no response to diet. Most families (96%, n = 113) were satisfied by the test and the therapy. There were only 21 tests (5%) with a borderline result because the criteria for a positive result were only partially met.ConclusionsHydrogen breath tests can be helpful in the evaluation of children with gastrointestinal symptoms including functional intestinal disorders. If applied for a variety of carbohydrates but only where indicated, around two-third of all children have positive results. The therapeutic consequences are successfully relieving symptoms in the vast majority of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

et al. 2014

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“…57 Malabsorption and intolerance to carbohydrates such as fructose and lactose are believed to cause symptoms such as bloating, diarrhea, and abdominal pain. 55 However, neither lactose nor fructose intolerance was established as a cause of pain in 220 children with RAP in a recent study, 58 and lactose restriction did not improve symptoms in pediatric trials. 39,40 Recently, diets of low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) have been extensively studied in adults.…”

Section: Alternative Medicinementioning

confidence: 99%

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

et al. 2015

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BACKGROUND AND OBJECTIVE: Various nonpharmacologic treatments are available for pediatric abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). Data on efficacy and safety are scarce. The goal of this study was to summarize the evidence regarding nonpharmacologic interventions for pediatric AP-FGIDs: lifestyle interventions, dietary interventions, behavioral interventions, prebiotics and probiotics, and alternative medicine.METHODS: Searches were conducted of the Medline and Cochrane Library databases. Systematic reviews and randomized controlled trials (RCTs) concerning nonpharmacologic therapies in children (aged 3-18 years) with AP-FGIDs were included, and data were extracted on participants, interventions, and outcomes. The quality of evidence was assessed by using the GRADE approach.RESULTS: Twenty-four RCTs were found that included 1390 children. Significant improvement of abdominal pain was reported after hypnotherapy compared with standard care/wait-list approaches and after cognitive behavioral therapy compared with a variety of control treatments/wait-list approaches. Written self-disclosure improved pain frequency at the 6-month follow-up only. Compared with placebo, Lactobacillus rhamnosus GG (LGG) and VSL#3 were associated with significantly more treatment responders (LGG relative risk: 1.31 [95% confidence interval: 1.08 to 1.59]; VSL#3: P , .05). Guar gum significantly improved irritable bowel syndrome symptom frequency; however, no effect was found for other fiber supplements (relative risk: 1.17 [95% confidence interval: 0.75 to 1.81]) or a lactose-free diet. Functional disability was not significantly decreased after yoga compared with a wait-list approach. No studies were found concerning lifestyle interventions; gluten-, histamine-, or carbonic acid-free diets; fluid intake; or prebiotics. No serious adverse effects were reported. The quality of evidence was found to be very low to moderate. CONCLUSIONS:Although high-quality studies are lacking, some evidence shows efficacy of hypnotherapy, cognitive behavioral therapy, and probiotics (LGG and VSL#3) in pediatric AP-FGIDs. Data on fiber supplements are inconclusive.

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“…Gijsbers et al (7) investigated malabsorption of lactose and fructose as causes of FAP in a group of 220 children (128 girls, mean age 8, years) utilizing the HBT with lactose load in 210 patients and fructose load in 121 patients. Malabsorption of lactose was found in 57 (27.0%) of 210 and of fructose in 79 (65.0%) of 121 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Another pathway of fructose absorption occurs when it is ingested with glucose, by the mechanism called solvent drag, through the tight junctions of the enterocytes (24) . When the concentration of fructose in a certain food is present in excess of glucose concentration, condition very frequently observed in various juice fruits, mainly in apple, pear and grape juices, some individuals may develop fructose malabsorption (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)20) .…”

Section: Introductionmentioning

confidence: 99%

Fructose Malabsorption in Children With Functional Digestive Disorders

Lozinsky

Boé

Palmero

et al. 2013

Arq. Gastroenterol.

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-Context -Fructose is a monosaccharide frequently present in natural and artificial juice fruits. When the concentration of fructose in certain food is present in excess of glucose concentration some individuals may develop fructose malabsorption. Objectives -To report the frequency of fructose malabsorption utilizing the hydrogen breath test in children with gastrointestinal and/ or nutritional disorders. Methods -Between July 2011 and July 2012, 43 patients with gastrointestinal and/or nutritional disorders, from both sexes, were consecutively studied, utilizing the hydrogen breath test with loads of the following carbohydrates: lactose, glucose, fructose and lactulose. Fructose was offered in a 10% aqueous solution in the dose of 1 g/kg body weight. Samples were collected fasting and at every 15 minutes after the intake of the aqueous solution for a 2 hour period. Malabsorption was considered when there was an increase of >20 ppm of hydrogen over the fasting level, and intolerance was diagnosed if gastrointestinal symptoms would appear. Results -The age of the patients varied from 3 months to 16 years, 24 were boys. The following diagnosis were established: irritable bowel syndrome with diarrhea in 16, functional abdominal pain in 8, short stature in 10, lactose intolerance in 3, celiac disease in 1, food allergy in 1 and giardiasis in 1 patient. Fructose malabsorption was characterized in 13 (30.2%) patients, and intolerance in 1 (2.3%) patient. The most frequent fructose malabsorption was characterized in 7 (16.3%) patients with irritable bowel syndrome and in 4 (9.3%) patients with functional abdominal pain. Conclusions -Patients with irritable bowel syndrome and functional abdominal pain were the main cause of fructose malabsorption.

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Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double‐blinded testing

Cited by 46 publications

References 32 publications

Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

Fructose Malabsorption in Children With Functional Digestive Disorders

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