Abstract
Background:The role of carbohydrate maldigestion or malabsorption remains unclear in patients with irritable bowel syndrome (IBS). The purpose of this study was to examine the impact of identifying lactose maldigestion (LM) and fructose malabsorption (FM) on patients with and without IBS.Methods:Patients who received lactose and fructose challenge testing formed the study group. Carbohydrate challenge testing was performed with 50 g lactose and 25 g fructose. Breath samples were collected and analyzed for hydrogen, methane, and CO2 (for correction) using a MicroLyzer Model SC (QuinTron Instrument Company, Milwaukee, WI). Questionnaires were used to assess Rome III IBS criteria, compliance with carbohydrate dietary modifications, and changes in symptoms.Results:One hundred and twenty-one of the 181 (67%) study subjects were able to be contacted 8 months to 4 years after carbohydrate testing. LM (21) and FM (2) were seen in 33% of the 66 IBS subjects. LM (12) and FM (9) were seen in 33% of the 55 subjects without IBS. Seventy-seven percent of IBS and 72% of those without IBS reported compliance with dietary advice. Of the subjects who reported compliance, 47% of IBS and 77% of those without IBS reported that, after identifying LM or FM, their symptoms resolved or improved.Conclusions:Carbohydrate maldigestion has a similar incidence in patients with and without IBS and both populations have similar compliance with therapeutic diets. However, patients without IBS are more likely to have improvement in symptoms when dietary changes are instituted when compared to IBS patients.
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References
References1. Tolliver BA, Jackson MS, Jackson KL, et al. Does lactose maldigestion really play a role in the irritable bowel? J Clin Gastroenterol 1996;23:15–17.TolliverBA]]JacksonMS]]JacksonKL&etal;Does lactose maldigestion really play a role in the irritable bowel?J Clin Gastroenterol19962315-172. Videlock EJ, Chang L. Irritable bowel syndrome: current approach to symptoms, evaluation and treatment. Gastroenterol Clin North Am 2007;36:665–685.VidelockEJ]]ChangLIrritable bowel syndrome: current approach to symptoms, evaluation and treatment.Gastroenterol Clin North Am200736665-6853. Choi YK, Kraft N, Zimmerman B, et al. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol 2008;42:233–238.ChoiYK]]KraftN]]ZimmermanB&etal;Fructose intolerance in IBS and utility of fructose-restricted diet.J Clin Gastroenterol200842233-2384. Vesa TH, Seppo LM, Marteau PR, et al. Role of irritable bowel syndrome in subjective lactose intolerance. Am J Clin Nutr 1998;67:710–715.VesaTH]]SeppoLM]]MarteauPR&etal;Role of irritable bowel syndrome in subjective lactose intolerance.Am J Clin Nutr199867710-7155. Gomara RE, Halata MS, Newman LJ, et al. Fructose intolerance in children presenting with abdominal pain. J Pediatr Gastroenterol Nutr 2008;47:303–308.GomaraRE]]HalataMS]]NewmanLJ&etal;Fructose intolerance in children presenting with abdominal pain.J Pediatr Gastroenterol Nutr200847303-3086. Gibson PR, Newnham E, Barrett JS, et al. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther 2007;25:349–363.GibsonPR]]NewnhamE]]BarrettJS&etal;Review article: fructose malabsorption and the bigger picture.Aliment Pharmacol Ther200725349-3637. Fernández-Bañares F, Rosinach M, Esteve M, et al. Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment. Clin Nutr 2006;25:824–831.Fernández-BañaresF]]RosinachM]]EsteveM&etal;Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment.Clin Nutr200625824-8318. Fernández-Bañares F, Esteve M, Salas A, et al. Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics. Am J Gastroenterol 2007;102:2520–2528.Fernández-BañaresF]]EsteveM]]SalasA&etal;Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics.Am J Gastroenterol20071022520-25289. Sheperd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc 2006;106:1631–1639.SheperdSJ]]GibsonPRFructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management.J Am Diet Assoc20061061631-163910. Mishkin D, Sablauskas L, Yalovsky M, et al. Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption. Dig Dis Sci 1997;42:2591–2598.MishkinD]]SablauskasL]]YalovskyM&etal;Fructose and sorbitol malabsorption in ambulatory patients with functional dyspepsia: comparison with lactose maldigestion/malabsorption.Dig Dis Sci1997422591-259811. Inman-Felton AE. Overview of lactose maldigestion (lactase nonpersistence). J Am Diet Assoc 1999;99:481–489.Inman-FeltonAEOverview of lactose maldigestion (lactase nonpersistence).J Am Diet Assoc199999481-48912. Saltzman JR, Russell RM. The aging gut. Nutritional issues. Gastroenterol Clin North Am 1998;27:309–324.SaltzmanJR]]RussellRMThe aging gut. Nutritional issues.Gastroenterol Clin North Am199827309-32413. Sibley E. Carbohydrate intolerance. Curr Opin Gastroenterol 2004;20:162–167.SibleyECarbohydrate intolerance.Curr Opin Gastroenterol200420162-16714. Gremse DA, Greer AS, Vacik J, et al. Abdominal pain associated with lactose ingestion in children and lactose intolerance. Clin Pediatr (Phila) 2003;42:341–345.GremseDA]]GreerAS]]VacikJ&etal;Abdominal pain associated with lactose ingestion in children and lactose intolerance.Clin Pediatr (Phila)200342341-34515. DiPalma AM, DiPalma JA. Recurrent abdominal pain and lactose maldigestion in school-aged children. Gastroenterol Nurs 1997;20:180–183.DiPalmaAM]]DiPalmaJARecurrent abdominal pain and lactose maldigestion in school-aged children.Gastroenterol Nurs199720180-18316. Gremse DA, Nguyenduc GH, Sacks AI, et al. Irritable bowel syndrome and lactose maldigestion in recurrent abdominal pain in childhood. South Med J 1999;92:778–781.GremseDA]]NguyenducGH]]SacksAI&etal;Irritable bowel syndrome and lactose maldigestion in recurrent abdominal pain in childhood.South Med J199992778-781
