Skip to main content
Log in

Fructose and Sorbitol Malabsorption in Ambulatory Patients with Functional Dyspepsia Comparison with Lactose Maldigestion/Malabsorption

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The aim of this study was to study sugarmaldigestion/malabsorption in patients with functionaldyspepsia using H breath testing. End-expiratory breathH after separate 2 challenges with lactose (25 g), fructose (25 g), and sorbitol (5 g) were usedto determine malabsorption, as well as small boweltransit time (SBTT). Five hundred twenty patients withfunctional dyspepsia received all three challenges. Smaller groups were also tested after lactulose(10 g, N = 36) and glucose (50 g, N = 90) challenges.Fructose and sorbitol were closely linked with respectto absorption and malabsorption status. Only in the case of lactose maldigestion/malabsorption wasthere a greater than random prevalence of malabsorption(P < 0.001) for fructose and sorbitol. In contrast tolactose, ethnic origin did not influence fructose or sorbitol malabsorption, and femalespredominated among fructose and sorbitol malabsorbers.In Jews, the prevalence of lactosemaldigestion/malabsorption decreased in the age group of25-55 and subsequently rose after 55, while fructose and sorbitolmalabsorption decreased progressively with advancingage. With respect to small bowel transit time (SBTT), inthe case of sorbitol and lactulose, it was significantly greater (P < 0.05) than those for fructoseand lactose. Multiple sugar malabsorptions are commonwhen lactose maldigestion/malabsorption ispresent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Kretchmer N: Memorial Lecture: Lactose and lactase—a historical perspective. Gastroenterology 61:805–813, 1971

    Google Scholar 

  2. Scrimshaw NS, Murray EB: The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Nutr 48:1083–1085, 1988

    Google Scholar 

  3. Di Palma JA, Narvaez RM: Prediction of lactose malabsorption in referral patients. Dig Dis Sci 33:303–307, 1988

    Google Scholar 

  4. Rumessen JJ, Gudmand-Hoyer E: Functional bowel disease: Malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Gastroenterology 95:694–700, 1988

    Google Scholar 

  5. Rumessen JJ: Review: Fructose and related food carbohydrates. Sources, intake, absorption and clinical implications. Scand J Gastroenterol 27:819–828, 1992

    Google Scholar 

  6. Fernandez-Banares F, Esteve-Pardo M, de Leon R, et al: Sugar malabsorption in functional bowel disease: Clinical implications. Am J Gastroenterol 88:2044–2050, 1993

    Google Scholar 

  7. Mishkin SR, Sablauskas L, Mishkin S: Fructose and/or sorbitol intolerance in a subgroup of lactose intolerant patients. Can J Gastroenterol 8:389–393, 1994

    Google Scholar 

  8. Paige DM, Bayless TM, Huang S, et al: Lactose hydrolyzed milk. Am J Clin Nutr 28:818–822, 1975

    Google Scholar 

  9. Saavedra M, Perman JA: current concepts in lactose malabsorption and intolerance. Annu Rev Nutr 9:475–502, 1989

    Google Scholar 

  10. Bayless TM, Rosensweig NS: A racial difference in the incidence of lactase deficiency. JAMA 197:968–972, 1966

    Google Scholar 

  11. Feibusch JM, Holt PR: Impaired absorptive capacity for carbohydrate in the aging human. Dig Dis Sci 12:1095–1100, 1982

    Google Scholar 

  12. Rao DM, Bello H, Warren AP, et al: Prevalence of lactose maldigestion: Influence and interaction of age, race, and sex. Dig Dis Sci 39:1519–1524, 1994

    Google Scholar 

  13. Jain NK, Rosenberg DB, Ulahannan MJ, et al: Sorbitol intolerance in adults. Am J Gastroenterol 80:678–681, 1985

    Google Scholar 

  14. Fritz G, Vermeeren M, Jansen W: Role of fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology 99:1016–1020, 1988

    Google Scholar 

  15. Hardinge MG, Swarner JB, Crooks H: Carbohydrates in foods. J Am Dietetic Assoc 46:197–204, 1965

    Google Scholar 

  16. Ladas SD, Haritos DN, Raptis SA: Honey may have a laxative effect on normal subjects because of incomplete fructose absorption. Am J Clin Nutr 62:1212–1215, 1995

    Google Scholar 

  17. Vuilleumier S: Worldwide production of high-fructose syrup and crystalline fructose. Am J Clin Nutr 58(suppl):733S–736S, 1993

    Google Scholar 

  18. Park YK, Yetley E: Intakes and food sources of fructose in the United States. Am J Clin Nutr 58(suppl):737S–747S, 1993

    Google Scholar 

  19. Uusitupa M: Fructose in the diabetic diet. Am J Clin Nutr 59(suppl):753S–757S, 1994

    Google Scholar 

  20. Beaugerie L, Flourie B, Marteau P, et al: Digestion and absorption in the human intestine of three sugar alcohols. Gastroenterology 99:717–723, 1990

    Google Scholar 

  21. Solomons NW: Evaluation of carbohydrate absorption: The hydrogen breath test in clinical practice. Clin Nutr J 3:71–78, 1984

    Google Scholar 

  22. Montes RG, Perman JA: Clinical assessment of carbohydrate malabsorption. Pediatr Gastroenterol Nutr 2:2–9, 1991

    Google Scholar 

  23. Tadesse K, Smith D, Eastwood MA: Breath hydrogen (H2) and methane (CH4) excretion patterns in normal man and in clinical practice. Q J Exp Physiol 65:85–97, 1980

    Google Scholar 

  24. King CE, Toskes PP: The use of breath tests in the study of malabsorption. Clin Gastroenterol 12:591, 1983

    Google Scholar 

  25. Bond JH, Levitt MD: Investigation of small bowel transit time in man utilizing pulmonary hydrogen (H2) measurements. J Lab Clin Med 85:546–555, 1975

    Google Scholar 

  26. Read NW: Small bowel transit time of food in man: Measurement, regulation and possible importance. Scand J Gastroenterol 96(suppl):77–85, 1984

    Google Scholar 

  27. King CE, Toskes PP: Comparison of the 1-gram [14C]xylose, 10-gram lactulose-H2, and 80-gram glucose H2 breath tests in patients with small intestine bacterial overgrowth. Gastroenterology 91:1447–1451, 1986

    Google Scholar 

  28. Kerlin P, Wong L: Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology 95:982–988, 1988

    Google Scholar 

  29. Tytgat GN: Patients with dyspepsia: A heterogeneous population. In Gastrointestinal Dysmotility: Focus on Cisapride. RC Heading, JD Wood (eds). New York, Raven Press, 1992

    Google Scholar 

  30. Manning AP, Thompson WG, Heaton KW, Morris AF: Towards positive diagnosis of the irritable bowel. Br Med J 2:653–654, 1978

    Google Scholar 

  31. Newcomer AD, McGill DB: Lactose tolerance tests in adults with normal lactase activity. Gastroenterology 50:340–346, 1966

    Google Scholar 

  32. Arola H, Tamm A: Metabolism of lactose in the human body. Scand J Gastroenterol 202(suppl):20–25, 1994

    Google Scholar 

  33. Kneepkens CMF, Vonk RJ, Fernandes J: Incomplete intestinal absorption of fructose. Arch Dis Childhood 59:735–738, 1984

    Google Scholar 

  34. Wallis JL, Lipski PS, Mathers JC, et al: Duodenal brush-border mucosal glucose transport and enzyme activities in aging man and effect of bacterial contamination of the small intestine. Dig Dis Sci 38(3):403–409, 1993

    Google Scholar 

  35. Ladas S, Papanikos J, Arapakis G: Lactose malabsorption in Greek adults: correlation of small bowel transit time with the severity of lactose intolerance. Gut 23:968–973, 1982

    Google Scholar 

  36. Macfarlane GT, Cummings JH: The colonic flora, fermentation and large bowel digestive function. In The Large Intestine: Physiology, Pathophysiology and Disease. S Phillip, JH Pemberton, RG Shorter (eds). New York, Raven Press, 1991, pp 51–92

    Google Scholar 

  37. Caride VJ, Prokop EK, Troncale F, Buddoura W, Winchenbach K, McCallum RW: Scintigraphic determination of small intestinal transit time: Comparison with the hydrogen breath technique. Gastroenterology 86:714–720, 1984

    Google Scholar 

  38. Albert V, Gilbert I, Greenberg G, Mishkin S: The “specific carbohydrate diet”: Nutritional quackery or of possible benefit for some IBD patients? Can J Gastroenterol 10(2):127–130, 1996

    Google Scholar 

  39. Mishkin S: Popular books and alternative medical practices available to our IBD patients—How to react? Can J Gastroenterol 10(5):342–346, 1996

    Google Scholar 

  40. Crook WG: The yeast connection—a medical breakthrough. New York, Random House, 1983

    Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sablauskas, D.M.L., Yalovsky, M. & Mishkin, S. Fructose and Sorbitol Malabsorption in Ambulatory Patients with Functional Dyspepsia Comparison with Lactose Maldigestion/Malabsorption. Dig Dis Sci 42, 2591–2598 (1997). https://doi.org/10.1023/A:1018841402133

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018841402133

Navigation