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Fructose breath hydrogen tests in infants with chronic non-specific diarrhoea
1Bosch Medicentrum, ME's-Hertogenbosch, The Netherlands.
Insights
Fructose malabsorption is common in children with chronic non-specific diarrhoea (CNSD). However, the fructose hydrogen (H2) breath test shows significant overlap with controls, making it unreliable for diagnosing CNSD in this age group.
Area of Science:
- Pediatric Gastroenterology
- Digestive Health
- Nutritional Science
Background:
- Chronic non-specific diarrhoea (CNSD) in young children is often linked to dietary factors, particularly clear fluids high in fructose.
- Fructose malabsorption has been suspected as a cause of CNSD in children aged 1-4 years.
Purpose of the Study:
- To evaluate the diagnostic utility of the fructose hydrogen (H2) breath test in identifying fructose malabsorption in children with CNSD.
- To compare H2 breath test results between children with CNSD and healthy controls.
Main Methods:
- 15 children diagnosed with CNSD and 35 healthy controls ingested 1 g/kg of fructose.
- Hydrogen (H2) levels in breath were measured post-ingestion to assess for malabsorption.
- Orocoecal transit time was also evaluated.
Main Results:
- 100% of CNSD children exhibited elevated breath H2 levels (≥20 ppm), compared to 49% of controls (P=0.0005).
- Median peak H2 levels were significantly higher in CNSD patients (90 ppm) than controls (20 ppm) (P<0.001).
- Despite differences, a significant overlap in H2 levels was observed between the CNSD and control groups, indicating limited diagnostic specificity.
Conclusions:
- The study demonstrates fructose malabsorption in children with CNSD but highlights the unreliability of the fructose H2 breath test due to significant overlap with control values.
- The findings strongly discourage the use of fructose H2 breath tests for diagnosing CNSD in children.
- Clinical practice should prioritize dietary history and empirical treatment over H2 breath testing for infants presenting with chronic non-specific diarrhoea.
Unlabelled:
Clear fluids high in fructose (e.g., apple juice) have been incriminated for symptoms of chronic non-specific diarrhoea (CNSD), in particular in children 1-4 years of age. H2 breath tests were performed, after ingestion of fructose (1 g/kg), in 15 patients referred with CNSD and 35 controls. All 15 CNSD children (100%) had breath peak H2 of > or = 20 ppm versus 49% of the 35 controls (P = 0.0005). Median peak H2 in CNSD (90 ppm, range 31-136) was significantly higher than in controls (20 ppm, range 1-139) (P < 0.001). Orocoecal transit time in children with positive tests was similar in both groups. Similarly, median H2 increases during the test period had the same distribution. We demonstrated fructose malabsorption in CNSD, but found a great overlap with the control group. Our results strongly discourage the use of fructose breath H2 tests in children suspected of CNSD. A positive test has no diagnostic value and a negative test has no clinical implications.
Conclusion:
For clinical practice, we suggest a dietary history and a trial of appropriate measures in infants with chronic nonspecific diarrhoea, instead of performing the fructose H2 breath test.