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Digestive Diseases and Sciences

, Volume 47, Issue 4, pp 886–893 | Cite as

Sugar Intolerance: Origin and Mechanisms of Symptoms?

  • Pauline Jouët
  • Jean-Marc Sabaté
  • Benoit Coffin
  • Yoram Bouhnik
  • Marc Lémann
  • Raymond Jian
  • Jean-Claude Rambaud
  • Bernard Flourié
Article

Abstract

The origin and mechanisms of symptoms in sugar intolerance were studied in 8 healthy volunteers. For two test periods, volunteers swallowed a probe with perfused catheters and an infusion catheter which migrated into the colon. A meal containing 40 g lactulose or 40 g sucrose was ingested; the sucrose meal was followed by colonic infusion of 40 g lactulose in order to bypass the small intestine. Recordings of small intestinal and colonic motility were performed. Abdominal pain, bloating, borborygmi, and flatulence were similar during both periods. Both meals increased small intestinal and colonic motility. Only 37% of the symptoms coincided in time with colonic motor events. Symptoms were not related to a specific motor event and were not correlated with breath hydrogen excretion. In conclusion, symptoms of sugar intolerance originate from the colon. They are not related to specific phasic motor events or to breath hydrogen excretion.

lactulose sugar intolerance malabsorption motility colon small intestine 

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REFERENCES

  1. 1.
    Suarez FL, Savaiano DA, Levitt MD: A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 333:1–4, 1995PubMedGoogle Scholar
  2. 2.
    Rambaud J-C, Flourié B: Mechanism of carbohydrate-induced diarrhoea. In Short Chain Fatty Acids. HJ Binder, J Cummings, K Soergel (eds). Hingham, Kluwer Academic Publishers, 1993, pp 232–239Google Scholar
  3. 3.
    Christopher NL, Bayless TM: Role of the small bowel and colon in lactose-induced diarrhea. Gastroenterology 60:845–852, 1971PubMedGoogle Scholar
  4. 4.
    Barrow L, Steed KP, Spiller RC, Watts PJ, Melia CD, Davies MC, Wilson CG: Scintigraphic demonstration of lactuloseinduced accelerated proximal colon transit. Gastroenterology 103:1167–1173, 1992PubMedGoogle Scholar
  5. 5.
    Bruley des Varannes S, Cherbut C, Schnee M, Delort-Laval J, Galmiche J-P: Effects of lactulose on fasting small intestine myoelectrical activity in humans. Eur J Gastroenterol Hepatol 4:539–545, 1992Google Scholar
  6. 6.
    Staniforth DH: Comparison of orocaecal transit times assessed by the lactulose/breath hydrogen and the sulphasalazine/ sulphapyridine methods. Gut 30:978–982, 1989PubMedGoogle Scholar
  7. 7.
    Yajima T: Contractile effect of short-chain fatty acids on the isolated colon of the rat. J Physiol 368:667–678, 1985PubMedGoogle Scholar
  8. 8.
    Blottière HM, Cherbut C, Boujtita N, Galmiche J-P: Effect of short-chain fatty acids on primary culture of colonic and ileal smooth muscle cell. Eur Symp GI Motil 6:155, 1994Google Scholar
  9. 9.
    Squires PE, Rumsey RDE, Edwards CA, Read NW: Effect of short-chain fatty acids on contractile activity and fluid flow in rat colon in vitro. Am J Physiol 262:G813–G817, 1992PubMedGoogle Scholar
  10. 10.
    Bennett A, Eley KG: Intestinal pH and propulsion: an explanation of diarrhoea in lactase deficiency and laxation by lactulose. J Pharm Pharmacol 28:192–195, 1975Google Scholar
  11. 11.
    Kellow JE, Miller LJ, Phillips SF, Haddad AC, Zinsmeister AR, Charboneau JW: Sensitivities of human jejunum, ileum, proximal colon and gallbladder to cholecystokinin octopeptide. Am J Physiol 252:G345–G356, 1987PubMedGoogle Scholar
  12. 12.
    Lémann M, Flourié B, Picon L, Coffin B, Jian R, Rambaud J-C: Motor activity recorded in the unprepared colon of healthy humans. Gut 37:649–653, 1995PubMedGoogle Scholar
  13. 13.
    Bassotti G, Betti C, Fusaro C, Morelli A: Colonic highamplitude propagated contractions (mass movements): repeated 24-h manometric studies in healthy volunteers. J Gastrointest Motil 4:187–191, 1992Google Scholar
  14. 14.
    Brummer R-JM, Karibe M, Stockbrügger RW: Lactose malabsorption. Optimalization of investigational methods. Scand J Gastroenterol 28:65–69, 1993Google Scholar
  15. 15.
    Kerlin P, Zinsmeister A, Phillips S: Relationship of motility to flow of contents in the human small intestine. Gastroenterology 82:701–706, 1982PubMedGoogle Scholar
  16. 16.
    Szurszewski JH: A migrating electric complex of canine small intestine. Am J Physiol 217:1757–1763, 1969PubMedGoogle Scholar
  17. 17.
    Radford E, Ferris B, Kriete B: Clinical use of a nomogram to estimate proper ventilation during artificial respiration. N Engl J Med 251:877–884, 1954PubMedGoogle Scholar
  18. 18.
    Solomons NW, Viteri FE, Hamilton LH: Application of a simple gas chromatographic technique for measuring breath hydrogen. J Lab Clin Med 90:856–862, 1977PubMedGoogle Scholar
  19. 19.
    Christl SU, Murgatroyd PR, Gibson GR, Cummings JH: Production, metabolism, and excretion of hydrogen in the large intestine. Gastroenterology 102:1269–1277, 1992PubMedGoogle Scholar
  20. 20.
    Steadman C, Kerlin P: Response of the human intestine to high volume infusion. Gut 35:641–645, 1994PubMedGoogle Scholar
  21. 21.
    Bassotti G, Gaburri M: Manometric investigation of highamplitude propagated contractile activity of the human colon. Am J Physiol 255:G660–G664, 1988Google Scholar
  22. 22.
    Narducci F, Bassotti G, Garburri M, Morelli A: Twenty four hour manometric recording of colonic motor activity in healthy man. Gut 28:17–25, 1987PubMedGoogle Scholar
  23. 23.
    Scrimshaw NS, Murray EB: Adaptation of lactose-maldigesting individuals to milk and milk products. Am J Clin Nutr 48:1118–1119, 1988Google Scholar
  24. 24.
    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, 1982PubMedGoogle Scholar
  25. 25.
    Rumessen JJ, Nordgaard-Andersen I, Gudmand-Hoyer E: Carbohydrate malabsorption: Quantification by methane and hydrogen breath tests. Scand J Gastroenterol 29:826–832, 1994PubMedGoogle Scholar
  26. 26.
    Hammer HF, Petritsch W, Pristautz H, Krejs GJ: Evaluation of the pathogenesis of flatulence and abdominal cramps in patients with lactose malabsorption. Wien Klin Wochenschr 108:175–179, 1996PubMedGoogle Scholar
  27. 27.
    Flourié B, Briet F, Florent C, Pellier P, Maurel M, Rambaud J-C: Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose? Am J Clin Nutr 58:369–375, 1993PubMedGoogle Scholar
  28. 28.
    Thompson DG, Wingate DL: Effects of osmoreceptor stimulation on human duodenal motor activity. Gut 29:173–180, 1988PubMedGoogle Scholar
  29. 29.
    Van Es AJH: Energy utilization of low digestibility carbohydrates. In Low Digestibility Carbohydrates. DC Leegwater, VJ Feron, RJJ Hermus (eds). Wageningen, Pudoc, 1987, pp 121–127Google Scholar
  30. 30.
    Lémann M, Picon L, Flourié B, Coffin B, Rambaud J, Rain J, Jian R: Relationship between high-amplitude propagated contractions and transit in the unprepared human colon. Gastroenterology 102:A474, 1992Google Scholar
  31. 31.
    Von der Ohe MR, Camilleri M, Kvols LK, Thomforde GM: Motor dysfunction of the small bowel and colon in patients with the carcinoid syndrome and diarrhea. N Engl J Med 329:1073–1078, 1993PubMedGoogle Scholar
  32. 32.
    Kamath PS, Phillips SF, O'Connor MK, Brown ML, Zinsmeister AR: Colonic capacitance and transit in man: Modulation by luminal contents and drugs. Gut 31:443–449, 1990PubMedGoogle Scholar
  33. 33.
    Svendsen P: Inhibition of cecal motility in sheep by volatile fatty acids. Nord Vet Med 24:393–396, 1972PubMedGoogle Scholar
  34. 34.
    Jouët P, Gorbatchef C, Flourié B, Coffin B, Lémann M, Franchisseur C, Dyard F, Jian R, Rambaud J-C: Colonic fermentation of lactulose produces a tonic contraction in the human colon. Gastroenterology 114:A773, 1998Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Pauline Jouët
    • 1
    • 2
  • Jean-Marc Sabaté
    • 1
    • 2
  • Benoit Coffin
    • 1
    • 2
  • Yoram Bouhnik
    • 1
    • 2
  • Marc Lémann
    • 1
    • 2
  • Raymond Jian
    • 1
    • 2
  • Jean-Claude Rambaud
    • 1
    • 2
  • Bernard Flourié
    • 1
    • 2
  1. 1.Unité de Recherche sur les Fonctions Intestinales, le Métabolisme et la Nutrition, INSERM U290Hôpital Saint-LazareParisFrance
  2. 2.Centre Hospitalier Lyon SudPierre-BeniteFrance

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