Fructose Intolerance/Malabsorption and Recurrent Abdominal Pain in Children

Abstract

Purpose: The purpose of this study was to ascertain if pediatric patients with chronic abdominal pain had concurrent fructose intolerance as determined by breath hydrogen test (BHT) using a standardized dose, and whether symptoms would improve with low-fructose diet. Methods: BHT-fructose test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating and/or diarrhea. Patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. A microlyzer self-correcting model SC QuinTron machine was used to measure hydrogen (H2) and methane (CH4) at time points 30 min, 60 min, and 90 min. Test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were started on a low-fructose diet as prescribed by a staff registered dietician. Results: Total of 245 patients. One hundred and fifty females (62.1%) were part of the study. Ages ranging from 2 to 18 years with a mean age of 11. Breath hydrogen test for fructose was performed in all patients and it was positive for fructose intolerance in 132/245 patients (53.9%). A total of 113/245 (46.1%) patients had negative BHT for fructose intolerance. The entire 132 patients with a positive BHT for fructose had a nutrition consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, Eighty-eight of the 132 patients (67.7%) reported resolution of symptoms on a low-fructose diet. Furthermore 54/113 patients (47.8%) with negative BHT for fructose reported resolution of symptoms without a low-fructose diet. Conclusion: Fructose intolerance/malabsorption is common in children with recurrent/functional abdominal pain and a low-fructose diet is an effective treatment.