Abdominal Pain in Children Between Fructose Intolerance and Small Bowel Bacterial Overgrowth, Another Factor to Treat

Abstract

Purpose: The purpose of this study is to ascertain if pediatric patients with fructose intolerance, who has had concurrent small bowel bacterial overgrowth (SBBO) showed better improvement of symptoms after SBBO treatment compared to low fructose diet alone. Methods: Breath hydrogen test was administered to patients evaluated in the pediatric gastroenterology clinic for unexplained chronic abdominal pain alone or associated with constipation, gas or bloating, and/or diarrhea. Patients were given a standard dose of 1g/kg fructose to a maximum of 25g. A microlyzer self-correcting model SC Quintron machine was used to measure Hydrogen (H2) and methane (CH4) at points 30 min, 60 min, 90 min and 120 min. Test was presumed positive for SBBO if breath hydrogen exceeded 20ppm above baseline within the first 45 min of BHT. All patients were started on a low-fructose diet as prescribed by a staff registered dietitian, In addition, all patients with SBBO were also treated. Results: Retrospectively, a total of 117 patients participated in this study. Ages ranged between 2-18 years (mean = 11); 59.83% of children were females. There was 39/117 (33.33%) patients with SBBO. After treatment for SBBO and on low fructose diet, 31/39 patients (79.5%) showed improvement or resolution of symptoms, compared to 50/78 (64.1%) on low fructose diet alone, that is a χ2 value (2.89) and an associated p value (0.089). Conclusion: Treatment of SBBO further enhanced the improvement or resolution of symptoms in children with fructose intolerance.