Skip to main content

Advertisement

SpringerLink
Log in

Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

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.

Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice.

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

BHT:

Breath hydrogen test

CAP:

Chronic abdominal pain

CI:

Confidence interval

References

  1. Casterton PL, Verbeke KA, Brouns F, Dammann KW (2012) Evaluation of sucromalt digestion in healthy children using breath hydrogen as a biomarker of carbohydrate malabsorption. Food Funct 3(4):410–413. https://doi.org/10.1039/c2fo10126b

    Article  CAS  PubMed  Google Scholar 

  2. Comité de Nutrición de la Asociación Española de Pediatría (2003) Consumo de zumos de frutas y de bebidas refrescantes por niños y adolescentes en España. Implicaciones para la salud de su mal uso y abuso. An Pediatr 58(6):584–593

    Article  Google Scholar 

  3. Däbritz J, Mühlbauer M, Domagk D, Voos N, Henneböhl G, Siemer ML, Foell D (2014) Significance of hydrogen breath tests in children with suspected carbohydrate malabsorption. BMC Pediatr 14:59. https://doi.org/10.1186/1471-2431-14-5918

    Article  PubMed  PubMed Central  Google Scholar 

  4. Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A (2001) Visceral hyperalgesia in children with functional abdominal pain. J Pediatr 139(6):838–843. https://doi.org/10.1067/mpd.2001.118883

    Article  PubMed  Google Scholar 

  5. Ebert K, Witt H (2016) Fructose malabsorption. Mol Cell Pediatr 3(1):10. https://doi.org/10.1186/s40348-016-0035-9

    Article  PubMed  PubMed Central  Google Scholar 

  6. Escobar MA Jr, Lustig D, Pflugeisen BM, Amoroso PJ, Sherif D, Saeed D, Shamdeen S, Tuider J, Abdullah B (2014) Fructose intolerance/malabsorption and recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr 58(4):498–501. https://doi.org/10.1097/MPG.0000000000000232

    Article  PubMed  Google Scholar 

  7. Frieling T, Kuhlbusch-Zicklam R, Kalde S, Heise J, Hülsdonk A, Kreysel C (2011) Fructose malabsorption: how much fructose can a healthy subject tolerate? Digestion. 84(4):269–272. https://doi.org/10.1159/000329570

    Article  CAS  PubMed  Google Scholar 

  8. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, Parodi A, Usai-Satta P, Vernia P, Anania C et al (2009) Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome consensus conference. Aliment Pharmacol Ther 29(Suppl 1):1–49. https://doi.org/10.1111/j.1365-2036.2009.03951.x

    Article  PubMed  Google Scholar 

  9. Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG (2007) Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 25(4):349–363. https://doi.org/10.1111/j.1365-2036.2006.03186.x

    Article  CAS  PubMed  Google Scholar 

  10. Giteling MJ, Bierna-Zeinstra SM, Lisman-van Leeuwen Y, Passchier J, Berger MY (2011) Prognostic factors for persistence of chronic abdominal pain in children. J Pediatr Gastroenterol Nutr 52(2):154–161. https://doi.org/10.1097/MPG.0b013e3181e82a2

    Article  Google Scholar 

  11. Gomara RE, Halata MS, Newman LJ, Bostwick HE, Berezin SH, Cukaj L, See MC, Medow MS (2008) Fructose intolerance in children presenting with abdominal pain. J Pediatr Gastroenterol Nutr 47(3):303–308. https://doi.org/10.1097/MPG.0b013e318166cbe4

    Article  CAS  PubMed  Google Scholar 

  12. Hammer V, Hammer K, Memaran N, Huber WD, Hammer K, Hammer J (2018) Relationship between abdominal symptoms and fructose ingestion in children with chronic abdominal pain. Dig Dis Sci 63(5):1270–1279. https://doi.org/10.1007/s10620-018-4997-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Helwig U, Koch AK, Koppka N, Holtmann S, Langhorst J (2019) The predictive value of the hydrogen breath test in the diagnosis of fructose malabsorption. Digestion. 99(2):140–147. https://doi.org/10.1159/000489877

    Article  PubMed  Google Scholar 

  14. Hoekstra JH, W van Kempen AAM, Bijl SB, Kneepkens CM (1993) Fructose breath hydrogen tests. Arch Dis Child 68(1):136–138

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Van Tilburg M (2016) Childhood functional gastrointestinal disorders: child/ adolescent. Gastroenterology 150:1456–1468. https://doi.org/10.1053/j.gastro.2016.02.015

    Article  Google Scholar 

  16. J Jones HF, Butler RN, Moore DJ, Brooks DA (2013) Developmental changes and fructose absorption in children: effect on malabsorption testing and dietary management. Nutr Rev 71(5):300–309. https://doi.org/10.1111/nure.12020

    Article  Google Scholar 

  17. Jones HF, Burt E, Dowling K, Davidson G, Brooks DA, Butler RN (2011) Effect of age on fructose malabsorption in children presenting with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 52(5):581–584. https://doi.org/10.1097/MPG.0b013e3181fd1315

    Article  CAS  PubMed  Google Scholar 

  18. Kneepkens CM, Vonk RJ, Fernandes J (1984) Incomplete intestinal absorption of fructose. Arch Dis Child 59(8):735–738

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lozinsky AC, Boé C, Palmero R, Fagundes-Neto U (2013) Fructose malabsorption in children with functional digestive disorders. Arq Gastroenterol 50(3):226–230. https://doi.org/10.1590/S0004-28032013000200040

    Article  PubMed  Google Scholar 

  20. Maagaard L, Ankersen DV, Végh Z, Burisch J, Jensen L, Pedersen N, Munkholm P (2016) Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol 22(15):4009–4019. https://doi.org/10.3748/wjg.v22.i15.4009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Nucera G, Gabrielli M, Lupascu A, Lauritano EC, Santoliquido A, Cremonini F, Cammarota G, Tondi P, Pola P, Gasbarrini G, Gasbarrini A (2005) Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment Pharmacol Ther 21(11):1391–1395. https://doi.org/10.1111/j.1365-2036.2005.02493.x

    Article  CAS  PubMed  Google Scholar 

  22. Rajilić-Stojanović M, Biagi E, Heilig HG, Kajander K, Kekkonen RA, Tims S, De Vos WM (2011) Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology 141(5):1792–1801. https://doi.org/10.1053/j.gastro.2011.07.043.9

    Article  PubMed  Google Scholar 

  23. Rajindrajith S, Zeevenhooven J, Devanarayana NM, Crispus Perera BJ, Benninga MA (2018) Functional abdominal pain disorders in children. Expert Rev Gastroenterol Hepatol 12(4):369–390. https://doi.org/10.1080/17474124.2018.1438188

    Article  CAS  Google Scholar 

  24. Rao SSC, Attaluri A, Anderson L, Stumbo P (2007) Ability of the normal human small intestine to absorb fructose: evaluation by breath testing. Clin Gastroenterol Hepatol 5(8):959–963. https://doi.org/10.1016/j.cgh.2007.04.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Saps M, Pensabene L, Turco R, Staiano A, Cupuro D, Di Lorenzo C (2009) Rotavirus gastroenteritis: precursor of functional gastrointestinal disorders? J Pediatr Gastroenterol Nutr 49(5):580–583. https://doi.org/10.1097/MPG.0b013e31819bcbd2

    Article  CAS  PubMed  Google Scholar 

  26. Scarpato E, Kolacek S, Jojkic-Pavkov D, Konjik V, Zivkovic ER, Kostovski A, Zdraveska N, Altamimi E, Papadopoulou A, Karagiozoglou-lampoudi T et al (2018) Prevalence of functional gastrointestinal disorders in children and adolescents in the Mediterranean region of Europe. Clin Gastroenterol Hepatol 16(6):870–876. https://doi.org/10.1016/j.cgh.2017.11.005

    Article  PubMed  Google Scholar 

  27. Siddiqui I, Ahmed S, Abid S (2016) Update on diagnostic value of breath test in gastrointestinal and liver diseases. World J Gastrointest Pathophysiol 7(3):256–265. https://doi.org/10.4291/wjgp.v7.i3.256

    Article  PubMed  PubMed Central  Google Scholar 

  28. Truswell AS, Seach JM, Thorbun AW (1988) Incomplete absorption of pure fructose in healthy subjects and the facilitating effect of glucose. Am J ClinNutr 48(6):1424–1430. https://doi.org/10.1093/ajcn/48.6.1424

    Article  CAS  Google Scholar 

  29. Tsampalieros A, Beauchamp J, Boland M, Mack DR (2008) Dietary fructose intolerance in children and adolescents. Arch Dis Child 93(12):1078. https://doi.org/10.1136/adc.2008.137521

    Article  CAS  PubMed  Google Scholar 

  30. Wilder-Smith CH, Olesen SS, Materna A, Drewes AM (2019) Repeatability and effect of blinding of fructose breath tests in patients with functional gastrointestinal disorders. Neurogastroenterol Motil 31(2):e13497. https://doi.org/10.1111/nmo.13497

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain

    Oihana Martínez-Azcona

  2. Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain

    Ana Moreno-Álvarez & Alfonso Solar-Boga

  3. Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain

    Teresa Seoane-Pillado

  4. University of Santiago de Compostela, Santiago de Compostela, Spain

    Inés Niño-Grueiro, Ana Ramiro-Comesaña, María Menéndez-Riera & Marta Pérez-Domínguez

  5. Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Complexo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain

    Rosaura Leis-Trabazo

Authors
  1. Oihana Martínez-Azcona
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Moreno-Álvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teresa Seoane-Pillado
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inés Niño-Grueiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana Ramiro-Comesaña
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. María Menéndez-Riera
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Pérez-Domínguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alfonso Solar-Boga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosaura Leis-Trabazo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Oihana Martínez-Azcona.

Ethics declarations

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.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Communicated by Peter de Winter

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martínez-Azcona, O., Moreno-Álvarez, A., Seoane-Pillado, T. et al. Fructose malabsorption in asymptomatic children and in patients with functional chronic abdominal pain: a prospective comparative study. Eur J Pediatr 178, 1395–1403 (2019). https://doi.org/10.1007/s00431-019-03418-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-019-03418-4

Keywords

Search

Navigation