Original Contribution
The American Journal of Gastroenterology (2003) 98, 1348–1353; doi:10.1111/j.1572-0241.2003.07476.x
Fructose intolerance: an under-recognized problem
Part of this study was presented at the 66thAnnual Scientific Meeting of the American College of Gastroenterology, Las Vegas, NV, October, 2001, and published as an abstract in the American Journal of Gastroenterology 2001;96:A1001.
Young K Choi MD1, Fredrick C Johlin Jr. MD1, Robert W Summers MD1, Michelle Jackson1 and Satish S C Rao MD, PhD1
1Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Correspondence: Satish S C Rao, MD, University of Iowa Hospital and Clinics, Division of Gastroenterology, 4612 JCP, 200 Hawkins Drive, Iowa City, IA, USA 52242
Received 9 September 2002; Revised 0000; Accepted 30 December 2002.
Abstract
Objectives
Although the role of lactose intolerance in the pathogenesis of abdominal symptoms is well known, the role of fructose intolerance is unclear. Our aims were 1) to examine the prevalence of fructose intolerance in patients with unexplained abdominal symptoms, and 2) to explore whether fructose concentration influences fructose breath test.
Methods
Over 2 yr, patients with unexplained symptoms answered questionnaires and underwent fructose breath tests. Patients received 50 g fructose in 150 ml water (33% solution). Breath samples were collected for hydrogen and methane. In a second study, breath test was performed after giving either 10%, 20%, or 33% fructose solution. Data were analyzed retrospectively.
Results
A total of 183 patients (50 male, 133 female) had breath tests, of whom 134 (73%) were positive. Among these, 119 (89%) had elevated H2, and 15 (11%) had elevated CH4 or both gases. Questionnaires showed that flatus (83%), pain (80%), bloating (78%), belching (70%), and altered bowel habit (65%) were the most common symptoms. Breath test reproduced symptoms in 101 patients (75%). In the second study, 14/36 (39%) tested positive with a 10% solution, 23/33 (70%) with a 20% solution, and 16/20 (80%) with a 33% solution (10% versus 20% or 33%, p < 0.01).
Conclusions
Fructose intolerance may cause unexplained GI symptoms. The higher yield of positive tests in our initial study may be due to referral bias or testing conditions; lower test dose produced a lower yield. Nonetheless, recognition and treatment of fructose intolerance may help many patients.
