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Fructose Intolerance/Malabsorption and Recurrent Abdominal Pain in Children

Escobar, Mauricio A. Jr*; Lustig, Daniel*; Pflugeisen, Bethann M.; Amoroso, Paul J.; Sherif, Dalia*; Saeed, Rasha*; Shamdeen, Shaza*; Tuider, Judith*; Abdullah, Bisher*

Journal of Pediatric Gastroenterology and Nutrition: April 2014 - Volume 58 - Issue 4 - p 498–501
doi: 10.1097/MPG.0000000000000232
Original Articles: Gastroenterology

Objectives: The purpose of the present study was to ascertain whether pediatric patients with chronic abdominal pain had concurrent fructose intolerance as determined by a standardized dose breath hydrogen test (BHT), and whether symptoms would improve with a low-fructose diet.

Methods: The fructose BHT test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating, and/or diarrhea. The patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. Hydrogen and methane were measured at 8 time points. The test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were given a dietitian-prescribed low-fructose diet.

Results: A total of 222 patients were part of the study. Ages ranged from 2 to 19 years with a mean of 10.5. BHT for fructose was performed in all of the patients and it was positive for fructose intolerance in 121 of 222 patients (54.5%). A total of 101 of 222 (45.5%) patients had negative BHT for fructose intolerance. All BHT-positive patients had a nutrition consult with a registered dietitian and were placed on a low-fructose diet. Using a standard pain scale for children, 93 of 121 patients (76.9%) reported resolution of symptoms on a low-fructose diet (P < 0.0001). Furthermore, 55 of 101 patients (54.4%) with negative BHT for fructose reported resolution of symptoms without a low-fructose diet (P = 0.37).

Conclusions: Fructose intolerance/malabsorption is common in children with recurrent/functional abdominal pain and a low-fructose diet is an effective treatment.

*Mary Bridge Children's Hospital and Health Center

MultiCare Institute for Research & Innovation, Tacoma, WA.

Address correspondence and reprint requests to Mauricio A. Escobar Jr, Pediatric Surgical Services, Mary Bridge Children's Hospital, PO Box 5299, MS: 311-3W-SUR, Tacoma, WA 98415 (e-mail:

Received 8 July, 2013

Accepted 24 October, 2013

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,