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Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption.
J Neurogastroenterol Motil 2014; 20(2):228-35JN

Abstract

BACKGROUND/AIMS

Carbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria.

METHODS

Patients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease.

RESULTS

Of the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) sympto-matic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than pa-tients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were sig-nificantly older than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy.

CONCLUSIONS

Carbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing.

Authors+Show Affiliations

Department of Internal Medicine, Institute of Neurogastroenterology and Motility, Martin-Luther Hospital, Academic Teaching Institution of Charité - University Medical Center, Berlin, Germany.Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.Department of Internal Medicine, Institute of Neurogastroenterology and Motility, Martin-Luther Hospital, Academic Teaching Institution of Charité - University Medical Center, Berlin, Germany.Department of Internal Medicine, Institute of Neurogastroenterology and Motility, Martin-Luther Hospital, Academic Teaching Institution of Charité - University Medical Center, Berlin, Germany.Charité Center for Internal Medicine and Dermatology, Division of General Internal and Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.Department of Internal Medicine, Institute of Neurogastroenterology and Motility, Martin-Luther Hospital, Academic Teaching Institution of Charité - University Medical Center, Berlin, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24840375

Citation

Goebel-Stengel, Miriam, et al. "Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption." Journal of Neurogastroenterology and Motility, vol. 20, no. 2, 2014, pp. 228-35.
Goebel-Stengel M, Stengel A, Schmidtmann M, et al. Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption. J Neurogastroenterol Motil. 2014;20(2):228-35.
Goebel-Stengel, M., Stengel, A., Schmidtmann, M., Voort, I. v., Kobelt, P., & Mönnikes, H. (2014). Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption. Journal of Neurogastroenterology and Motility, 20(2), pp. 228-35. doi:10.5056/jnm.2014.20.2.228.
Goebel-Stengel M, et al. Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption. J Neurogastroenterol Motil. 2014 Apr 30;20(2):228-35. PubMed PMID: 24840375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption. AU - Goebel-Stengel,Miriam, AU - Stengel,Andreas, AU - Schmidtmann,Marco, AU - Voort,Ivo van der, AU - Kobelt,Peter, AU - Mönnikes,Hubert, PY - 2013/11/19/received PY - 2014/02/26/revised PY - 2014/02/27/accepted PY - 2014/5/21/entrez PY - 2014/5/21/pubmed PY - 2014/5/21/medline KW - Breath tests KW - Fructose KW - Hydrogen KW - Irritable bowel syndrome KW - Lactose SP - 228 EP - 35 JF - Journal of neurogastroenterology and motility JO - J Neurogastroenterol Motil VL - 20 IS - 2 N2 - BACKGROUND/AIMS: Carbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria. METHODS: Patients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease. RESULTS: Of the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) sympto-matic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than pa-tients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were sig-nificantly older than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy. CONCLUSIONS: Carbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing. SN - 2093-0879 UR - https://www.unboundmedicine.com/medline/citation/24840375/full_citation L2 - http://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2014.20.2.228 DB - PRIME DP - Unbound Medicine ER -