Optimal Testing for Diagnosis of Fructose Intolerance: Over-dosage Leads to False Positive Intolerance Test

Erdoğan, Aşkın; Adame, Enrique Coss; Yu, Siegfried; Rattanakovit, Kulthep; Rao, Satish S.C.

doi:10.5056/jnm14085

Cited by 7 publications

(3 citation statements)

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“… 43 Another series, which compared 3 doses of fructose load (15, 25, and 50 g), also demonstrated that 100% of healthy volunteers could absorb 15 g of fructose, 90% could absorb 25 g of fructose, but only 20 to 30% could absorb 50 g. 25 Altogether these findings suggest that the physiologic dose of 25 g fructose appears to be relevant to characterize clinically significant fructose malabsorption, higher doses leading to false-positive diagnosis of fructose malabsorption. 42 …”

Section: Discussionmentioning

confidence: 99%

Fructose Malabsorption in Systemic Sclerosis

et al. 2015

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The deleterious effect of fructose, which is increasingly incorporated in many beverages, dairy products, and processed foods, has been described; fructose malabsorption has thus been reported in up to 2.4% of healthy subjects, leading to digestive clinical symptoms (eg, pain, distension, diarrhea). Because digestive involvement is frequent in patients with systemic sclerosis (SSc), we hypothesized that fructose malabsorption could be responsible for intestinal manifestations in these patients.The aims of this prospective study were to: determine the prevalence of fructose malabsorption, in SSc; predict which SSc patients are at risk of developing fructose malabsorption; and assess the outcome of digestive symptoms in SSc patients after initiation of standardized low-fructose diet.Eighty consecutive patients with SSc underwent fructose breath test. All SSc patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated.The prevalence of fructose malabsorption was as high as 40% in SSc patients. We also observed a marked correlation between the presence of fructose malabsorption and: higher values of GSS score of digestive symptoms (P = 0.000004); and absence of delayed gastric emptying (P = 0.007). Furthermore, in SSc patients with fructose malabsorption, the median value of GSS score of digestive symptoms was lower after initiation of standardized low-fructose diet (4 before vs. 1 after; P = 0.0009).Our study underscores that fructose malabsorption often occurs in SSc patients. Our findings are thus relevant for clinical practice, highlighting that fructose breath test is a helpful, noninvasive method by: demonstrating fructose intolerance in patients with SSc; and identifying the group of SSc patients with fructose intolerance who may benefit from low-fructose diet. Interestingly, because the present series also shows that low-fructose diet resulted in a marked decrease of gastrointestinal clinical manifestations in SSc patients with fructose malabsorption, our findings underscore that fructose malabsorption may play a significant role in the onset of gastrointestinal symptoms in these patients. Finally, we suggest that fructose malabsorption may be due to reduced fructose absorption by enterocytes, impaired enteric microbiome, and decreased intestinal permeability.

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Section: Discussionmentioning

confidence: 99%

Fructose Malabsorption in Systemic Sclerosis

et al. 2015

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“…increase above baseline for H 2 or for combined H 2 and CH 4 11 , 15 – 18 . In 3 subjects with diabetes, fructose breath test was performed using previously described methods 19 .…”

Section: Methodsmentioning

confidence: 99%

Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis

Rao

Rehman

et al. 2018

Clinical and Translational Gastroenterology

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114

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BackgroundD-lactic acidosis is characterized by brain fogginess (BF) and elevated D-lactate and occurs in short bowel syndrome. Whether it occurs in patients with an intact gut and unexplained gas and bloating is unknown. We aimed to determine if BF, gas and bloating is associated with D-lactic acidosis and small intestinal bacterial overgrowth (SIBO).MethodsPatients with gas, bloating, BF, intact gut, and negative endoscopic and radiological tests, and those without BF were evaluated. SIBO was assessed with glucose breath test (GBT) and duodenal aspiration/culture. Metabolic assessments included urinary D-lactic acid and rblood L-lactic acid, and ammonia levels. Bowel symptoms, and gastrointestinal transit were assessed.ResultsThirty patients with BF and 8 without BF were evaluated. Abdominal bloating, pain, distension and gas were the most severe symptoms and their prevalence was similar between groups. In BF group, all consumed probiotics. SIBO was more prevalent in BF than non-BF group (68 vs. 28%, p = 0.05). D-lactic acidosis was more prevalent in BF compared to non-BF group (77 vs. 25%, p = 0.006). BF was reproduced in 20/30 (66%) patients. Gastrointestinal transit was slow in 10/30 (33%) patients with BF and 2/8 (25%) without. Other metabolic tests were unremarkable. After discontinuation of probiotics and a course of antibiotics, BF resolved and gastrointestinal symptoms improved significantly (p = 0.005) in 23/30 (77%).ConclusionsWe describe a syndrome of BF, gas and bloating, possibly related to probiotic use, SIBO, and D-lactic acidosis in a cohort without short bowel. Patients with BF exhibited higher prevalence of SIBO and D-lactic acidosis. Symptoms improved with antibiotics and stopping probiotics. Clinicians should recognize and treat this condition.

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“…The patients were identified as fructose malabsorbers after routine clinical testing with 35 g of fructose. Malabsorption of fructose is dose‐dependent ; for example, in 20 healthy subjects, none malabsorbed a dose of 15 g #bib10% malabsorbed 25 g and 80% malabsorbed 50 g , and most healthy subjects can absorb up to 25 g of fructose . Thus, it was not surprising then that breath hydrogen responses to 25 g of fructose were relatively attenuated.…”

Section: Discussionmentioning

confidence: 99%