Relationship Between Abdominal Symptoms and Fructose Ingestion in Children with Chronic Abdominal Pain

Abstract

Background: Limited valid data are available regarding the association of fructose-induced symptoms, fructose malabsorption, and clinical symptoms.

Aim: To develop a questionnaire for valid symptom assessment before and during a carbohydrate breath test and to correlate symptoms with fructose breath test results in children/adolescents with functional abdominal pain.

Methods: A Likert-type questionnaire assessing symptoms considered relevant for hydrogen breath test in children was developed and underwent initial validation. Fructose malabsorption was determined by increased breath hydrogen in 82 pediatric patients with functional abdominal pain disorders; fructose-induced symptoms were quantified by symptom score ≥2 and relevant symptom increase over baseline. The results were correlated with clinical symptoms. The time course of symptoms during the breath test was assessed.

Results: The questionnaire exhibited good psychometric properties in a standardized assessment of the severity of carbohydrate-related symptoms. A total of 40 % (n = 33) had malabsorption; symptoms were induced in 38 % (n = 31), but only 46 % (n = 15) with malabsorption were symptomatic. There was no significant correlation between fructose malabsorption and fructose-induced symptoms. Clinical symptoms correlated with symptoms evoked during the breath test (p < 0.001, r² = 0.21) but not with malabsorption (NS). Malabsorbers did not differ from non-malabsorbers in terms of symptoms during breath test. Symptomatic patients had significantly higher pain and flatulence scores over the 9-h observation period (p < 0.01) than did nonsymptomatic patients; the meteorism score was higher after 90 min.

Conclusions: Fructose-induced symptoms but not fructose malabsorption are related to increased abdominal symptoms and have distinct timing patterns.

Keywords: Adolescents; Children; Fructose malabsorption; Functional abdominal pain; Hypersensitivity.

Fig. 1

End-expiratory breath hydrogen (ppm) over time in fructose malabsorbers who were fructose sensitive and not sensitive to fructose, respectively. Mean ± SEM values are shown

Fig. 2

Global symptom scores in preceding 4 weeks reported by children and adolescents with functional abdominal pain disorders. Median ± 25 and 75 % quartiles are shown. NS, not significant

Fig. 3

Severity of abdominal symptoms in preceding 4 weeks reported by children and adolescents with functional abdominal pain disorders, comparing a patients with and without fructose malabsorption, and b patients with or without sensitivity for fructose. Median ± 25 and 75 % quartiles are shown. p-value <0.01 was considered significant considering multiple comparisons

Fig. 4

Time course of individual symptoms during fructose breath test in children and adolescents with functional abdominal pain disorders with or without sensitivity to fructose. Mean ± SEM values are shown. p-Value <0.01 [difference of symptoms compared with baseline (0 min)] was considered significant considering multiple comparisons. Asterisks denote p value <0.05 (*), <0.01 (**), and <0.001 (***)