Fructose and irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a chronic disorder characterised by recurrent abdominal pain or discomfort and transit disturbances with heterogeneous pathophysiological mechanisms. The link between food and gastrointestinal (GI) symptoms is often reported by patients with IBS and the role of fructose has recently been highlighted. Fructose malabsorption can easily be assessed by hydrogen and/or methane breath test in response to 25 g fructose; and its prevalence is about 22 % in patients with IBS. The mechanism of fructose-related symptoms is incompletely understood. Osmotic load, fermentation and visceral hypersensitivity are likely to participate in GI symptoms in the IBS population and may be triggered or worsened by fructose. A low-fructose diet could be integrated in the overall treatment strategy, but its role and implication in the improvement of IBS symptoms should be evaluated. In the present review, we discuss fructose malabsorption in adult patients with IBS and the interest of a low-fructose diet in order to underline the important role of fructose in IBS.

Perceived Gastrointestinal Symptoms and Association With Meals in a French Cohort of Patients With Irritable Bowel Syndrome

“…18 The role of sugar such as fructose and fat in IBS symptoms has already been highlighted in the past. 5,19 Therefore, an observational study in real life in France is useful for a better understanding of the relation between meals and GI symptoms. Indeed, the results of international studies are difficult to extrapolate to French dietary habits.…”

Temporal Relationships Between Abdominal Pain, Psychological Distress and Coping in Patients With IBS – A Time Series Approach

“…P2 was a woman in her late 20s, employee, suffering from diarrhea-dominant IBS (main symptom pain), fructose malabsorption, depression, and social phobia. Fructose malabsorption is common in IBS and does not rule out the diagnosis of irritable bowel syndrome, particularly when improvement is not obtained following an appropriate diet ( 31 – 33 ). Of note is that this patient P2 had a generally high abdominal pain and daily impairment in her self-report data with almost no fluctuation.…”

Mechanisms Underlying Food-Triggered Symptoms in Disorders of Gut-Brain Interactions

“…Hence, the luminal fructose concentration, but also the amount of glucose, influence fructose absorption ( 31 ). Malabsorption of 25 g of fructose can be identified in approximately 20% of patients with IBS ( 30 ), which may be higher than in control populations. However, the mechanisms underlying symptom generation after fructose ingestion, i.e.…”

“…The involvement of fructose malabsorption in the generation of symptoms in patients with DGBIs has also received significant attention recently ( 30 ). Fructose is a monosaccharide that is slowly absorbed in the small intestine by carrier-mediated facilitated diffusion, predominantly via 2 fructose carriers belonging to the glucose transport (GLUT) family of sugar transporters, GLUT5 and GLUT2.…”