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Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective
Oihana Martínez-Azcona1, Ana Moreno-Álvarez2, Teresa Seoane-Pillado3
1Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. oihana.martinez.azcona@sergas.es.
Insights
Fructose malabsorption is less common in children with chronic abdominal pain than in healthy children. Dietary changes may improve symptoms, suggesting greater fructose intolerance in these patients.
Area of Science:
- Pediatric Gastroenterology
- Digestive Health
- Nutritional Science
Background:
- Fructose malabsorption is often linked to chronic abdominal pain, but robust evidence is limited.
- The accuracy of breath hydrogen testing for fructose malabsorption in children with abdominal pain is debated.
Purpose of the Study:
- To compare the prevalence of fructose malabsorption between children with functional chronic abdominal pain and healthy children.
- To assess the impact of a low-fructose diet on symptom improvement in children with diagnosed fructose malabsorption.
Main Methods:
- A prospective cohort study involving 105 children (71 with functional gastrointestinal disorders, 34 healthy controls).
- Standardized breath hydrogen testing was used to diagnose fructose malabsorption.
- Participants with positive tests received a low-fructose diet, and symptom response was evaluated.
Main Results:
- Fructose malabsorption was identified in 58.8% of healthy children and 40.8% of children with chronic abdominal pain.
- Children with chronic abdominal pain and a positive test showed a 72.4% improvement in symptoms after adopting a low-fructose diet.
- Bacterial overgrowth was excluded to ensure accurate fructose malabsorption assessment.
Conclusions:
- Fructose malabsorption is more prevalent in asymptomatic children than in those with functional chronic abdominal pain.
- Symptom improvement on a low-fructose diet suggests fructose intolerance, even without a higher malabsorption rate in the pain group.
- Standardization of diagnostic tests is crucial for improving accuracy in clinical practice.
Abstract:
The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%-76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%-53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice. What is Known: • Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking. • Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain. What is New: • Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children. • Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.
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