Objectives: The purpose of this study was to ascertain if 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: BHT-fructose test was administered to patients evaluated in clinic with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating and/or diarrhea. Patients were given a standard dose of 1 g/kg fructose to maximum of 25 g. Hydrogen and methane were measured at three 30-minute intervals. The test was presumed positive if breath hydrogen exceeded 20 ppm above baseline. If positive, patients were started on a dietician-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. Breath hydrogen test for fructose was performed in all patients and it was positive for fructose intolerance in 121/222 patients (54.5%). A total of 101/222 (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, 93/121 patients (76.9%) reported resolution of symptoms on a low fructose diet (P < 0.0001). Furthermore 55/101 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.
(C) 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,