Diagnosis of dyspeptic symptomsȁUnderestimated relevance of malabsorption of sorbitol, fructose, lactose and impact of diet

Abstract

Background and aims: Patients are diagnosed as having dyspepsia, when regular laboratory data and no structural abnormalities are found. Dyspeptic symptoms, affecting the intestinal tract, producing symptoms of e.g. pain, bloating, belching, flatulence, diarrhoea, cramps, halitosis or any combination may deteriorate the quality of life severely and are often classified as functional. Treatment is symptomatically. As all these symptoms could possibly be explained by malabsorption and the dynamics of intestinal gas production induced by malabsorbed diet, we studied the impact of malabsorption in patients with non-ulcer dyspepsia (NUD) Methods: Absorption of lactose, sorbitol and fructose as the three most relevant substrates 2470 adults with at least 5 of 9 NUD-symptoms were investigated by means of the hydrogen breath test ( Bedfont EC 60, England ). 10 g sorbitol, respectively 50 g fructose and 50 g lactose diluted in 100 ml water were given after a 10 hour fasting period. Malabsorption was judged by a peak breath H2 excretion of at least 20 ppm. Results: 36,3 % of the 2470 patients with a minimum of 5 of the 9 NUD-symptoms showed malabsorption of sorbitol, 35,6 % fructose, 28,1% lactose, 26,2 % two of three substrates, 10,2 % all three substrates. 18,4 % of the patients developed clinical symptoms during the test. By avoiding the malabsorbed component of the diet, 84,3 % of the dyspeptic patients improved considerably. Conclusion: Whereas dyspeptic symptoms are often experienced severely impacting daily life and NUD-thagnosis is extremely expensive and time consuming, a quick diagnosis is often possible with a simple and inexpensive diagnostic first line approach using three hydrogenbreath tests to evaluate malabsorption of sorbitol, fructose and lactose. Our results show the highly relevant impact of dyspepsia due to malabsorption. Treatment by avoiding the malabsorbed agents is simple, effective and highly cost effective. Frequency of malabsorption is underestimated. Whereas lactose malabsorption is generally well known, diagnosis of fructose or sorbitol malabsorption are not usual. An optimised case history and the use of multiple hydrogen breath tests should be considered as additional necessary basic tools in diagnosis of dyspepsia.