Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study
The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%–76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%–53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.
What is Known:
• Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking.
• Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain.
What is New:
• Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children.
• Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.
KeywordsChronic abdominal pain Rome IV Fructose malabsorption Fructose intolerance Low-fructose diet
Breath hydrogen test
Chronic abdominal pain
Oihana Martinez Azcona: acquisition, analysis and interpretation of data, redaction of the manuscript.
Ana Moreno Álvarez: design of the work, acquisition and interpretation of data, redaction and review of the manuscript.
Teresa Seoane Pillado: design of the work, statistical analysis, review of the manuscript.
Inés Niño Grueiro: acquisition and analysis of data, review of the manuscript.
Ana Ramiro Comesaña: acquisition and analysis of data, review of the manuscript.
María Menéndez Riera: acquisition and analysis of data, review of the manuscript.
Marta Pérez Domínguez: acquisition and analysis of data, review of the manuscript.
Alfonso Solar Boga: design of the work, redaction and review of the manuscript.
Rosaura Leis Trabazo: design of the work, review of the manuscript.
Compliance with ethical standards
The study was conducted in accordance with the Declaration of Helsinki (7th revision), the Spanish regulations on observational studies (Order SAS 3470/2009), and Spanish personal data protection law (Law 15/ 1999). The study protocol was approved by the Ethics Committee of A Coruña, Spain. Parents or legal representatives of all patients gave written informed consent before inclusion, and patients over 12 years old also signed informed assent. All data were anonymized.
Conflict of interest
The authors declare that they have no conflict of interest.
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