Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Issue 11 (9th April 2013)

• Record Type: Journal Article
• Authors: Wilder‐Smith, C. H.; Materna, A.; Wermelinger, C.; Schuler, J.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 37:Issue 11(2013)
• Page Start: 1074
• Page End: 1083
• Publication Date: 2013-04-09
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12306
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" xml:lang="en" id="apt12306-abs-0001"> <title>Summary</title> <sec id="apt12306-sec-0001" sec-type="section"> <title>Background</title> <p>The association of fructose and lactose intolerance and malabsorption with the symptoms of different functional gastrointestinal disorders (FGID) remains unclear.</p> </sec> <sec id="apt12306-sec-0002" sec-type="section"> <title>Aim</title> <p>To investigate the prevalence of fructose and lactose intolerance (symptom induction) and malabsorption and their association with clinical gastrointestinal (GI) as well as non‐GI symptoms in FGID and the outcome of dietary intervention.</p> </sec> <sec id="apt12306-sec-0003" sec-type="section"> <title>Methods</title> <p>Fructose and lactose intolerance (defined by positive symptom index) and malabsorption (defined by increased hydrogen/methane) were determined in 1372 FGID patients in a single centre using breath testing. Results were correlated with clinical symptoms in different FGID Rome III subgroups. The effectiveness of a targeted saccharide‐reduced diet was assessed after 6–8 weeks.</p> </sec> <sec id="apt12306-sec-0004" sec-type="section"> <title>Results</title> <p>Intolerance prevalence across all FGIDs was 60% to fructose, 51% to lactose and 33% to both. Malabsorption occurred in 45%, 32% and 16% respectively. There were no differences in intolerance or malabsorption prevalence between FGID subgroups. FGID symptoms correlated with symptoms evoked during testing (<italic>r</italic> = 0.35–0.61. <italic>P</italic> < 0.0001), but not with malabsorption. Non‐GI symptoms occurred more commonly in patients with intolerances. Methane breath levels were not associated with constipation using several cut‐off thresholds. Adequate symptom relief was achieved in >80% of intolerant patients, irrespective of malabsorption.</p> </sec> <sec id="apt12306-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Fructose and lactose intolerances are common in FGID and associated with increased non‐GI symptoms, but not with specific FGID subtypes. Symptoms experienced during breath testing, but not malabsorption, correlate with FGID symptoms. Effective symptom relief with dietary adaptation is not associated with malabsorption. Mechanisms relating to the generation of GI and non‐GI symptoms due to lactose and fructose in FGID need to be explored further.</p> </sec> </abstract>