Increased serum amylase and lipase in fructose malabsorbers

Background: Fructose malabsorption is frequently seen in the general popula tion and is characterised by the inability to absorb fructose efficiently. Due to fructose malabsorption, fructose reaches the colon where it is broke n down by bacteria to short fatty acids, CO2 and H-2. Bloating, cramps, osm otic diarrhea and other symptoms of irritable bowel syndrome are the conseq uence. We recently found that fructose malabsorption is associated with low plasma folic acid concentrations and low serum tryptophan and zinc. Becaus e fructose malabsorption apparently is associated not only with mal absorpt ion of other nutrients, but also with abdominal discomfort. it was of inter est to examine whether mild pancreatitis may be involved. Methods: We retro spectively examined our data in 159 otherwise healthy adults (110 females, 49 males) aged 14-84 years (mean 45.6 +/- 14.4 S.D.) with gastrointestinal complaints for serum amylase and serum lipase concentrations. The patients have been tested earlier for fructose malabsorption and lactose maldigestio n by measuring breath H-2 concentrations after an oral dose of 25 g fructos e and 50 - lactose, respectively 1 week apart. Results: Fructose malabsorpt ion (H-2 concentrations greater than or equal to 20 ppm over baseline value s) was detected in 107 of 159 individuals (67.3%). These subjects with fruc tose malabsorption presented with significantly higher serum amylase concen trations (73.1 U/I +/- 25.7 S.D.) compared to individuals with normal fruct ose absorption (59.6 U/l + 17.9 S.D: p = 0.0009). Fructose malabsorbers als o presented with higher serum lipase concentrations (122.0 U/l +/- 100.3 S. D.) compared to normals (89.5 U/l +/- 46.5 S.D.: p < 0.05). To determine wh ether this finding is a consequence of any sort of malabsorption syndrome o r whether it is specific for fructose malabsorption, all subjects were scre ened for lactose maldigestion. Lactose maldigestion (H-2 concentrations > 2 0 ppm over baseline after lactose loading) was found in 50 of 159 individua ls (31.4%). There were no significant differences in either amylase or lipa se concentrations in lactose maldigestors. Conclusion Serum amylase and lip ase concentrations are higher in subjects with fructose malabsorption compa red to normals. Therefore, fructose malabsorption should be considered as a differential diagnosis in moderately elevated serum amylase. (C) 2001 Else vier Science B.V. All rights reserved.