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Abstract
Background: Carbohydrate malabsorption is a frequent digestive problem associated with abdominal pain, bloating and diarrhea. Hydrogen breath testing (BT) represents the most reliable and validated diagnostic technique. The aim of this manuscript was to clarify the usefulness of BTs in the nutritional management of these disorders. Methods: A literature search for BT related to carbohydrate malabsorption was carried out using the online databases of Pubmed, Medline and Cochrane. Results: Lactose BT showed good sensitivity and optimal specificity for lactose malabsorption. However, an accurate diagnosis of lactose intolerance should require blind lactose challenge although this method is difficult to utilize in clinical practice. Regarding dose-depending fructose and sorbitol malabsorption, BTs could not add diagnostic advantage compared with a direct dietary intervention. In addition, carbohydrates are fundamental components of fermentable oligo-, di- and monosaccharides and polyols (FODMAPs). Before starting a low FODMAP diet, lactose BT should be suggested in a population with low prevalence of hypolactasia. Conclusions: BTs represent a valid and noninvasive technique in many digestive conditions. Regarding the management of carbohydrate intolerance, lactose BT can be recommended with some limitations. No sufficient evidence is available about the usefulness of BTs for other sugars in clinical practice.
Highlights
Carbohydrate malabsorption is a frequent clinical condition which may be responsible for digestive symptoms such as abdominal pain, bloating and diarrhea both in adults and in children [1]
In clinical practice, breath testing (BT) is performed with various substrates, such as lactose, fructose and sorbitol for carbohydrate malabsorption; glucose for small intestinal bacterial overgrowth; and lactulose for orocecal transit
The mechanism of poor absorption is thought to be related to a low-capacity transport mechanism across the epithelium, reduced activity of brush border hydrolases, lack of hydrolases or molecules being too large for absorption [6]
Summary
Carbohydrate malabsorption is a frequent clinical condition which may be responsible for digestive symptoms such as abdominal pain, bloating and diarrhea both in adults and in children [1]. Fructose and sorbitol are relevant components of fermentable oligo-, di- and monosaccharides and polyols, the so-called FODMAPs [6]. The mechanism by which these malabsorbed sugars may cause symptoms is related to an osmotic action that increases the volume of intestinal contents and leads the undigested carbohydrates to be fermented by the colonic flora. The usefulness of BT in proving the responsibility of sugar malabsorption for intolerance symptoms remains controversial. The aim of this review was to clarify if hydrogen BT can be useful to guide nutritional intervention in the presence of digestive intolerances. We searched for the diagnostic usefulness and validity of BT in the nutritional management of carbohydrate malabsorption and intolerance. The search was performed in various combinations with the Boolean operators “and”, “or” and “not”, selecting articles published in English
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