Sugar Malabsorption in Functional Bowel Disease: Clinical Implications

F. Fernández‐Bañares, M. Esteve‐Pardo, R. de Leon, P. Humbert, E. Cabré, J. M. Llovet, M. A. Gassull

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136 Scopus citations


Objective: To investigate the relationship of sugar malabsorption to the development of clinical symptoms in functional bowel disease. Methods: Twenty‐five consecutive outpatients [five men, 20 women; mean age 38.7 ± 2.6 (SEM) yr] with functional bowel disease and symptoms suggestive of carbohydrate malabsorption were studied. Twelve healthy subjects [six men, six women; mean age 35.7 ± 3.7 (SEM) yr] acted as the control group. Sugar malabsorption was assessed by breath‐hydrogen test after an oral load of various solutions containing lactose (50 g), fructose (25 g), sorbitol (5 g), fructose plus sorbitol (25+5 g), and sucrose (50 g). The severity of symptoms developing after sugar challenge was studied. In addition, the effect on clinical symptoms of a diet free of the offending sugars, compared to a low‐fat diet, was assessed. Results: Frequency of sugar malabsorption was high in both patients and controls, with malabsorption of at least one sugar in more than 90% of the subjects. Median symptom scores after both lactose [median 6; interquartile (IQ) range 3–7 [and fructose plus sorbitol (median 2; IQ range 0–4) malabsorption were significantly higher than after sucrose load (median 1; IQ range 0–1.5) in functional bowel disease patients (p= 0.001 and p= 0.007, respectively). However, there were no differences in healthy controls. In addition, symptoms score after both lactose and fructose plus sorbitol malabsorption was significantly higher in patients than in control subjects (p= 0.02 and p= 0.008, respectively). On the other hand, H2 production capacity, as measured following lactulose load, was significantly higher in patients than in controls. The clinical symptoms improved in 40% of the evaluated patients after restriction of the offending sugars. Conclusions: These results suggest that sugar malabsorption may be implicated in the development of abdominal distress in at least a subset of patients with functional bowel disease.

Original languageEnglish
Pages (from-to)2044-2050
Number of pages7
JournalAmerican Journal of Gastroenterology
Issue number12
StatePublished - Dec 1993
Externally publishedYes


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