Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption.

Content Provider	Europe PMC
Author	Goebel-Stengel, Miriam Stengel, Andreas Schmidtmann, Marco van der Voort, Ivo Kobelt, Peter Mönnikes, Hubert
Copyright Year	2014
Abstract	Background/AimsCarbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria.MethodsPatients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease.ResultsOf the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomatic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than patients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were significantly older than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy.ConclusionsCarbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing.
ISSN	20930879
Journal	Journal of Neurogastroenterology and Motility
Volume Number	20
PubMed Central reference number	PMC4015196
Issue Number	2
PubMed reference number	24840375
e-ISSN	20930887
DOI	10.5056/jnm.2014.20.2.228
Language	English
Publisher	Korean Society of Neurogastroenterology and Motility
Publisher Date	2014-04-01
Access Restriction	Open
Rights License	This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2014 The Korean Society of Neurogastroenterology and Motility
Subject Keyword	Breath tests Fructose Hydrogen Irritable bowel syndrome Lactose
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Gastroenterology