Fructose intolerance, or fructose malabsorption, is common in children with recurrent or functional abdominal pain, but the condition can be effectively managed with a low-fructose diet, according to the results of a new study unveiled Oct 18 at the American College of Gastroenterology’s annual meeting.
The study, “Fructose Intolerance/Malabsorption and Recurrent Abdominal Pain in Children,” investigated a total of 245 patients with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating and/or diarrhea - 150 of them female (62.1%) - who ranged in age from 2 to 18 years old, with a median age of 11.
[Note: Fructose is fruit sugar, high in some fruits, some vegetables, wines, high-fructose corn syrup and honey. Fructose intolerance involves a deficiency of ‘fructose carrier’ in the lining of the small intestine where nutrients are broken down for absorption into the blood stream. The problem leads to high fructose concentrations in the large intestine, where it causes problems. Lists of fruits & other foods that are OK/not OK appear to vary quite a bit, likely because fructose & tolerance levels vary, so a dietitian’s advice may help.]
Diagnosis and Testing
Fructose intolerance is typically diagnosed by exclusion, according to researcher Daniel Lustig, MD, a pediatric gastroenterologist with the Mary Bridge Children’s Hospital and Health Center in Tacoma, WA. He explained that once other GI conditions like Crohn’s disease and ulcerative colitis are ruled out, a hydrogen breath test is given to the patient. If the patient’s breath hydrogen exceeds 20 points above baseline, then the patient is likely fructose intolerant.
Breath hydrogen test (BHT) for fructose was performed in all patients in the study and:
• It was positive for fructose intolerance in 132 of 245 patients (53.9%).
• A total of 113 of 245 (46.1%) of patients had a negative BHT for fructose intolerance. [No sign of intolerance.]
All of the 132 patients with a positive BHT for fructose had a nutritional consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, 88 of the 132 patients (67.7%) reported resolution of symptoms on a low-fructose diet.
“With fructose in everything from fruit to pre-packaged products, soft drinks and honey, it is difficult to avoid, so the challenge is finding those foods without fructose and still maintaining a healthy nutritional balance,” said Dr. Lustig.
More Prevalent in Teenage Girls
He said fructose intolerance is more prevalent in teenage girls with chronic abdominal pain. In his practice, Dr. Lustig said he typically sees three or four teenage girls a week with a new diagnosis of fructose intolerance or for follow-up.
“While there is definitely a subset of patients who respond well to a low-fructose diet, it’s challenging for patients who are fructose intolerant to maintain, especially teenagers,” says Dr. Lustig.
“But the good news is that over half of patients who are fructose intolerant are able to maintain a low-fructose diet and are able to notice an immediate improvement in their symptoms.”
Source: American College of Gastroenterology news release, Oct 18, 2010