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Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain.
Nutrients. 2019 Dec 16; 11(12)N

Abstract

Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7-12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP.

Authors+Show Affiliations

University Medical Centre Ulm, Department for Pediatric and Adolescent Medicine, Pediatric Gastroenterology, 89075 Ulm, Germany.University Medical Centre Ulm, Department for Pediatric and Adolescent Medicine, Pediatric Gastroenterology, 89075 Ulm, Germany.Darmstädter Kinderkliniken Prinzessin Margaret, Dieburger Str. 31, 64287 Darmstadt, Germany.Katholisches Kinderkrankenhaus Wilhelmsstift, Liliencronstr.130, 22149 Hamburg, Germany.Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Pediatric Gastroenterology, Augustenburger Platz 1, 13353 Berlin, Germany.St. Vincenz-Krankenhaus GmbH Paderborn, Klinik für Kinder- und Jugendmedizin, Husener Str. 81, 33098 Paderborn, Germany.Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, 13353 Berlin, Germany. University of Potsdam, Department Psychology, Counseling Psychology, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany.University of Potsdam, Department Psychology, Counseling Psychology, Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31888122

Citation

Posovszky, Carsten, et al. "Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting With Chronic Abdominal Pain." Nutrients, vol. 11, no. 12, 2019.
Posovszky C, Roesler V, Becker S, et al. Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain. Nutrients. 2019;11(12).
Posovszky, C., Roesler, V., Becker, S., Iven, E., Hudert, C., Ebinger, F., Calvano, C., & Warschburger, P. (2019). Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain. Nutrients, 11(12). https://doi.org/10.3390/nu11123063
Posovszky C, et al. Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting With Chronic Abdominal Pain. Nutrients. 2019 Dec 16;11(12) PubMed PMID: 31888122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Roles of Lactose and Fructose Malabsorption and Dietary Outcomes in Children Presenting with Chronic Abdominal Pain. AU - Posovszky,Carsten, AU - Roesler,Vreni, AU - Becker,Sebastian, AU - Iven,Enno, AU - Hudert,Christian, AU - Ebinger,Friedrich, AU - Calvano,Claudia, AU - Warschburger,Petra, Y1 - 2019/12/16/ PY - 2019/10/27/received PY - 2019/12/01/revised PY - 2019/12/09/accepted PY - 2020/1/1/entrez PY - 2020/1/1/pubmed PY - 2020/8/25/medline KW - children KW - chronic abdominal pain KW - fructose malabsorption KW - functional abdominal pain disorders KW - hydrogen breath test KW - lactose intolerance JF - Nutrients JO - Nutrients VL - 11 IS - 12 N2 - Intolerance to lactose or fructose is frequently diagnosed in children with chronic abdominal pain (CAP). However, the causal relationship remains a matter of discussion. A cohort of 253 patients, aged 7-12 years, presenting with unexplained CAP received standardized diagnostics. Additional diagnostic tests were performed based on their medical history and physical and laboratory investigations. Fructose and lactose hydrogen breath tests (H2BT) as well as empiric diagnostic elimination diets were performed in 135 patients reporting abdominal pain related to the consumption of lactose or fructose to evaluate carbohydrate intolerance as a potential cause of CAP. Carbohydrate malabsorption by H2BT was found in 55 (41%) out of 135 patients. An abnormal increase in H2BT was revealed in 30% (35/118) of patients after fructose consumption and in 18% (20/114) of patients after lactose administration. Forty-six percent (25/54) reported pain relief during a diagnostic elimination diet. In total, 17 patients had lactose malabsorption, 29 fructose malabsorption, and nine combined carbohydrate malabsorption. Carbohydrate intolerance as a cause of CAP was diagnosed at follow-up in only 18% (10/55) of patients with malabsorption after the elimination of the respective carbohydrate. Thus, carbohydrate malabsorption appears to be an incidental finding in children with functional abdominal pain disorders, rather than its cause. Therefore, testing of carbohydrate intolerance should only be considered in children with a strong clinical suspicion and with the goal to prevent long-term unnecessary dietary restrictions in children suffering from CAP. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/31888122/Roles_of_Lactose_and_Fructose_Malabsorption_and_Dietary_Outcomes_in_Children_Presenting_with_Chronic_Abdominal_Pain_ L2 - https://www.mdpi.com/resolver?pii=nu11123063 DB - PRIME DP - Unbound Medicine ER -