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. 2013 Jun;37(11):1074-83.
doi: 10.1111/apt.12306. Epub 2013 Apr 9.

Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders

C H Wilder-Smith  1 , A Materna, C Wermelinger, J Schuler
Affiliations
Free PMC article

Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders

C H Wilder-Smith et al. Aliment Pharmacol Ther. 2013 Jun.
Free PMC article

Abstract

Background: The association of fructose and lactose intolerance and malabsorption with the symptoms of different functional gastrointestinal disorders (FGID) remains unclear.

Aim: To investigate the prevalence of fructose and lactose intolerance (symptom induction) and malabsorption and their association with clinical gastrointestinal (GI) as well as non-GI symptoms in FGID and the outcome of dietary intervention.

Methods: Fructose and lactose intolerance (defined by positive symptom index) and malabsorption (defined by increased hydrogen/methane) were determined in 1372 FGID patients in a single centre using breath testing. Results were correlated with clinical symptoms in different FGID Rome III subgroups. The effectiveness of a targeted saccharide-reduced diet was assessed after 6-8 weeks.

Results: Intolerance prevalence across all FGIDs was 60% to fructose, 51% to lactose and 33% to both. Malabsorption occurred in 45%, 32% and 16% respectively. There were no differences in intolerance or malabsorption prevalence between FGID subgroups. FGID symptoms correlated with symptoms evoked during testing (r = 0.35-0.61. P < 0.0001), but not with malabsorption. Non-GI symptoms occurred more commonly in patients with intolerances. Methane breath levels were not associated with constipation using several cut-off thresholds. Adequate symptom relief was achieved in >80% of intolerant patients, irrespective of malabsorption.

Conclusions: Fructose and lactose intolerances are common in FGID and associated with increased non-GI symptoms, but not with specific FGID subtypes. Symptoms experienced during breath testing, but not malabsorption, correlate with FGID symptoms. Effective symptom relief with dietary adaptation is not associated with malabsorption. Mechanisms relating to the generation of GI and non-GI symptoms due to lactose and fructose in FGID need to be explored further.

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Figures

Figure 1
Figure 1
Prevalence of fructose and lactose intolerances in Rome III-defined Irritable Bowel Syndrome (IBS) (n = 212), Functional Dyspepsia (FD) (n = 606), Functional Bloating (FB) (n = 109) and their subgroups, IBS-c: IBS with constipation (n = 37), IBS-d: IBS with diarrhoea (n = 67), IBS-m: IBS with alternating constipation and diarrhoea (n = 94), IBS-u: unclassified IBS (n = 14), FD-ppd: Functional Dyspepsia with postprandial distress (n = 368), FD-eps: Functional Dyspepsia with epigastric pain syndrome (n = 238) and FB: Functional Bloating (n = 109).
Figure 2
Figure 2
Percentages of patients with Functional Gastrointestinal Disorders (FGID) with symptoms provoked during fructose or lactose breath testing (n = 1372).
Figure 3
Figure 3
Percentages of patients with Functional Gastrointestinal Disorders (FGID) with fructose (n = 613) or lactose (n = 432) malabsorption, i.e. an increase of H2 > 20 ppm or CH4>10 ppm over baseline, with diarrhoea or constipation. *P < 0.05 constipation vs. diarrhoea for both fructose and lactose.
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