Abstract
Various techniques which assess carbohydrate (CHO) absorption are available. Determinations of stool pH and reducing substances are nonspecific, and oral CHO tolerance tests assume that gastric emptying and monosaccharide transport are normal. Breath hydrogen analysis quantitates intestinal bacterial degradation of unabsorbed CHO. We have developed a high performance liquid chromatographic (HPLC) technique to qualitate and quantitate unabsorbed CHO in feces. Individual dietary mono-saccharides and disaccharides can be identified. We can detect <1 mg CHO/g fresh stool. Mean recovery rates for fructose, glucose, galactose, sucrose and lactose were greater than 85% over a range of 15-70 mg CHO/g spiked stool. Only maltose demonstrated fecal degradation with 34% recovered as maltose and 50% as glucose. Four “normal” newborns less than two weeks of age had no detectable CHO in their stools. Twelve infants <1 year old with watery, acidic stools were evaluated; 7 had unabsorbed fecal CHO up to 173 mg/g stool. Six of the 12 were evaluated with CHO tolerance tests during convalescence; 3 patients with normal tolerance tests had no fecal CHO while the other 3 had flat tolerance tests and up to 15 mg CHO/g stool during the test. HPLC stool analysis identifies a variety of digestion/absorption defects. A single stool specimen is required and qualitative information is available in one hour.
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