Symptom Provocation in Irritable Bowel Syndrome Effects of Differing Doses of Fructose-Sorbitol

Abstract

The role of fructose and sorbitol, when ingested together, in the aetiology of irritable bowel syndrome (IBS) is controversial. The aims of this study in IBS patients, therefore, were to compare differences in symptom provocation with various doses of fructose-sorbitol and to relate differences in the extent of colonic hydrogen production after each dose to such symptom provocation. Two different mixtures of fructose and sorbitol--20 g fructose plus 3.5 g sorbitol ('lower' dose) and 25 g fructose plus 5 g sorbitol ('higher' dose)--were administered to 15 patients with IBS and to 24 healthy controls. Breath hydrogen concentrations were determined at 10-min intervals for 3 h after ingestion of each mixture, and the presence and severity of a range of gastrointestinal symptoms were recorded on a standard form before, during, and after the study. Total symptom score in IBS patients, but not controls, was greater (p < 0.05) after the higher than after the lower dose of fructose-sorbitol mixture, and, for the higher dose, symptoms were significantly greater in IBS patients than in controls (p < 0.05). Moreover, the increase in total symptom score between the higher and lower dose mixtures was of a greater magnitude (p = 0.01) in IBS patients than in controls. No significant correlation was observed between the increase in symptom score and the increase in peak hydrogen concentration or the increase in integrated hydrogen response between lower and higher dose mixtures, although these latter increases were at times substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction

“…In the current study, rats subjected to RS showed an increased relative abundance of Gram-negative bacteria, as well as an increase in LPS levels in the colon, accompanied by mucosal inflammation and impaired gut permeability. These abnormalities are similar to those observed in IBS patients (17,19,20). In the current study, we show for the first time to our knowledge that 2-week LFM prevents the development of mucosal inflammation, impaired permeability, and visceral hypersensitivity evoked by stress.…”

“…Ingestion of sugar (lactose or fructose), sorbitol, and oligosaccharides (fructans) alone or in combination may trigger abdominal symptoms (1,17,18). However, the mechanisms responsible for symptom generation in IBS remain poorly understood.…”

Hydrogen Breath Tests in Gastrointestinal Diseases

“…In 1978, Andersson and Nygren [22] first reported cases of fructose malabsorption in which patients received a positive result using the breath hydrogen test. It has been suggested that fructose malabsorption or intolerance occurs more frequently in individuals with compromised gut function as compared with healthy individuals [23,24]. Study by Rao et al [25] revealed that healthy subjects completely absorbed a dose of 15 g fructose.…”

Self-reported dietary fructose intolerance in irritable bowel syndrome: Proposed diagnostic criteria

“…The exact mechanisms leading to incomplete fructose absorption are unknown, and in the literature, they are described as ranging from a true condition to a variance of normality [5] . Moreover, it is well established that factors such as dietary sorbitol [6,7] and dietary non-hydrolysable fructans [8] aggravate IBS symptoms [9] . The amount of sorbitol needed to provoke IBS symptoms appears to be ≥ 10 g [10] .…”