Fructose Malabsorption in Children with Recurrent Abdominal Pain: Positive Effects of Dietary Treatment

Wintermeyer, Philip; Baur, Meike; Pilic, Denisa; Schmidt‐Choudhury, Anjona; Wirth, S.

doi:10.1055/s-0031-1279747

Cited by 21 publications

(36 citation statements)

References 18 publications

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“…In addition, a trend was found for fructose consumption to be higher in IBS patients than HCs. More research is needed before conclusions can be drawn, but results do appear to suggest that adolescents with IBS may inadvertently increase fructose consumption as other nutrients are excluded, which has the potential to aggravate ongoing symptoms and pain . Findings suggest that youth with IBS may benefit from routine nutrition counseling to guide food decision choices, especially with regards to replacing calories lost secondary to dietary restrictions.…”

Section: Discussionmentioning

confidence: 99%

“…More research is needed before conclusions can be drawn, but results do appear to suggest that adolescents with IBS may inadvertently increase fructose consumption as other nutrients are excluded, which has the potential to aggravate ongoing symptoms and pain. 24,25 Findings suggest that youth with IBS may benefit from routine nutrition counseling to guide food decision choices, especially with regards to replacing calories lost secondary to dietary restrictions. In addition, no differences were found between groups in disordered eating symptoms in an attempt to influence shape or weight as measured by the Eating Disorders Examination Questionnaire.…”

Section: Discussionmentioning

confidence: 99%

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Adolescents with irritable bowel syndrome report increased eating‐associated symptoms, changes in dietary composition, and altered eating behaviors: a pilot comparison study to healthy adolescents

Reed-Knight

Squires

Chitkara

et al. 2016

Neurogastroenterology Motil

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Background About half of adult Irritable Bowel Syndrome (IBS) patients report symptoms with eating and disordered eating habits. However little is known about eating in adolescent IBS patients, a common age at which eating disorders develop. The aim of the study was to investigate if adolescents with IBS are more likely than healthy controls to experience eating associated symptoms, report disordered eating patterns, and show differences in diet composition. Methods A total of 99 adolescents between 15–21 years-of-age participated (n=48 IBS; n=51 healthy controls (HC)). All subjects completed three 24-hour dietary recalls and questionnaires on eating associated symptoms (EAS) and disordered eating. Key Results IBS patients were more likely to report eating associated symptoms than HC (91.7% vs 28%, p<0.001). Eating associated symptoms were controlled by avoiding the offending food (97.7%), not eating any food even when hungry (43.2%), or vomiting after eating (13.6%). Compared to HC, IBS patients reported reduced daily intake of overall calories (1828 vs 2139; p<.05), fat (65.4gr vs 81.4 gr, p<.05) and lactose (8.2gr vs 12.8gr, p<.01). No differences were found between IBS and HC in screening for disordered eating patterns or BMI, though IBS patients endorsed using potentially unhealthy eating behaviors in an attempt to control symptoms. Conclusions & Inferences Eating associated symptoms are very common in adolescents with IBS and associated with changes in eating behaviors and dietary composition. They do not appear to change BMI and risk for eating disorders. More research is needed to guide adolescents with IBS in making appropriate dietary changes to control eating associated symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adolescents with irritable bowel syndrome report increased eating‐associated symptoms, changes in dietary composition, and altered eating behaviors: a pilot comparison study to healthy adolescents

Reed-Knight

Squires

Chitkara

et al. 2016

Neurogastroenterology Motil

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“…Those on the fructose-restricted diet (irrespective of their fructose hydrogen breath test result) had less pain intensity; however, they did not have a decrease in pain frequency [24]. In a prospective observational study, Wintermeyer et al [25] placed 75 children with RAP, all of whom had a positive fructose breath test, on a restricted fructose diet. Overall pain frequency and pain severity decreased while on the diet [25].…”

Section: Carbohydrate Intolerancementioning

confidence: 99%

“…In a prospective observational study, Wintermeyer et al [25] placed 75 children with RAP, all of whom had a positive fructose breath test, on a restricted fructose diet. Overall pain frequency and pain severity decreased while on the diet [25]. …”

Section: Carbohydrate Intolerancementioning

confidence: 99%

Dietary Carbohydrates and Childhood Functional Abdominal Pain

Chumpitazi

Shulman²

2016

Ann Nutr Metab

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Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.

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“…CAP is mostly considered functional; however, in up to 45% of cases, organic abnormalities are found [5,6]. Lactose and fructose malabsorption are frequently reported in children suffering from CAP [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

et al. 2019

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Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7–12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.

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Fructose Malabsorption in Children with Recurrent Abdominal Pain: Positive Effects of Dietary Treatment

Abstract: Our study provides evidence that dietary fructose restriction represents a useful approach to address recurrent abdominal symptoms in children with fructose malabsorption.

Cited by 21 publications

References 18 publications

Adolescents with irritable bowel syndrome report increased eating‐associated symptoms, changes in dietary composition, and altered eating behaviors: a pilot comparison study to healthy adolescents

Adolescents with irritable bowel syndrome report increased eating‐associated symptoms, changes in dietary composition, and altered eating behaviors: a pilot comparison study to healthy adolescents

Dietary Carbohydrates and Childhood Functional Abdominal Pain

Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain

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