Extra increase in exhaled hydrogen during fructose malabsorption breath tests is linked to additional food intolerance/malabsorption and/or Helicobacter pylori

Food intolerance/malabsorption, including fructose malabsorption (FM), histamine intolerance (HIT), lactose intolerance (LIT), and Helicobacter pylori (H. pylori), may present with symptoms similar to symptoms of the irritable bowel syndrome (IBS) spectrum. We aimed to investigate whether extra food intolerances/malabsorption and H. pylori infection affect the results of hydrogen breath tests in FM patients.

A hydrogen (H₂) breath test was conducted for evaluating FM and LIT. A serum diamine oxidase value determination, a search for H. pylori and antibodies to tissue transglutaminase were made. A retrospective analysis of 318 patients with FM identified 50 with FM-only, 50 FM patients with HIT and 50 FM patients with additional LIT, 50 FM and HIT patients also had LIT. Thirty-one FM patients had H. pylori, 26 FM patients had HIT and H. pylori and 40 FM patients had LIT and H. pylori, and 21 had FM, HIT, LIT and H. pylori.

With the Kruskal-Wallis test we compared the area under the curve (AUC) and demonstrated that H₂ was significantly elevated in FM with LIT and FM and H. pylori patients compared to those with FM-only (p = 0.039, respectively). The comparison of the AUCs of FM-only to FM, LIT, and HIT (p = 0.006) and to FM, LIT, and HIT with H. pylori revealed a significant elevation (p = 0.026) in H₂ values.

In patients diagnosed with FM, the presence of additional food intolerance/malabsorption and H. pylori infection has been demonstrated to significantly increase expiratory H₂ values during fructose H₂ breath tests.