F. Fernandezbanares et al., SUGAR MALABSORPTION IN FUNCTIONAL BOWEL-DISEASE - CLINICAL IMPLICATIONS, The American journal of gastroenterology, 88(12), 1993, pp. 2044-2050
Objective: To investigate the relationship of sugar malabsorption to t
he development of clinical symptoms in functional bowel disease. Metho
ds: Twenty-five consecutive outpatients [five men, 20 women; mean age
38.7 +/- 2.6 (SEM) yr] with functional bowel disease and symptoms sugg
estive of carbohydrate malabsorption were studied. Twelve healthy subj
ects [six men, six women; mean age 35.7 +/- 3.7 (SEM) yr] acted as the
control group. Sugar malabsorption was assessed by breath-hydrogen te
st after an oral load of various solutions containing lactose (50 g),
fructose (25 g), sorbitol (5 g), fructose plus sorbitol (25+5 g), and
sucrose (50 g). The severity of symptoms developing after sugar challe
nge was studied. In addition, the effect on clinical symptoms of a die
t free of the offending sugars, compared to a low-fat diet, was assess
ed. Results: Frequency of sugar malabsorption was high in both patient
s and controls, with malabsorption of at least one sugar in more than
90% of the subjects. Median symptom scores after both lactose [median
6; interquartile (IQ) range 3-71 and fructose plus sorbitol (median 2;
IQ range 0-4) malabsorption were significantly higher than after sucr
ose load (median 1; IQ range 0-1.5) in functional bowel disease patien
ts (p = 0.001 and p = 0.007, respectively). However, there were no dif
ferences in healthy controls. In addition, symptoms score after both l
actose and fructose plus sorbitol malabsorption was significantly high
er in patients than in control subjects (p = 0.02 and p = 0.008, respe
ctively). On the other hand, H-2 production capacity, as measured foll
owing lactulose load, was significantly higher in patients than in con
trols. The clinical symptoms improved in 40% of the evaluated patients
after restriction of the offending sugars. Conclusions: These results
suggest that sugar malabsorption may be implicated in the development
of abdominal distress in at least a subset of patients with functiona
l bowel disease.