Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

Carsten Posovszky,Sebastian Becker,Christian Hudert,Friedrich Ebinger,Vreni Roesler,Claudia Calvano,Enno Iven,Petra Warschburger

doi:10.3390/nu11123063

Abstract

Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7–12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.

Highlights

Chronic abdominal pain (CAP) is one of the most frequent complaints in children and adolescents with prevalence rates ranging from 0.3% to 19% in Western countries [1,2]
hydrogen breath test (H2 BT) revealed an abnormal increase over baseline (∆H2 > 20 ppm) with the presence of typical symptoms in 30% (35/118) of patients after fructose and 18% (20/114) after lactose load
H2 BT levels did not match the symptoms in six cases of fructose and one of lactose load (Table 2)

Summary

Introduction

Chronic abdominal pain (CAP) is one of the most frequent complaints in children and adolescents with prevalence rates ranging from 0.3% to 19% in Western countries [1,2]. CAP is mostly considered functional; in up to 45% of cases, organic abnormalities are found [5,6]. Lactose and fructose malabsorption are frequently reported in children suffering from CAP [7,8,9,10,11]. Diarrhea, flatulence, and nausea are common symptoms that occur after the ingestion of juice and dairy products due to osmotic effects and fermentation processes of the colonic microbiota in carbohydrate intolerant children [14]

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