Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment.
BACKGROUND
Functional abdominal bloating is a functional bowel disorder dominated by a feeling of abdominal fullness without sufficient criteria for another functional gastrointestinal disorder. Gas-related complaints (i.e., passage of flatus), which are present in a subgroup of these patients, might be associated with carbohydrate malabsorption.


OBJECTIVE
To evaluate the presence of lactose and/or fructose plus sorbitol malabsorption, and the long-term efficacy of malabsorbed sugar-free diets, in patients with Rome II criteria of functional abdominal bloating and gas-related symptoms.


METHODS
Thirty-six consecutive patients (age, 51+/-3.1 years; sex, 12 M, 24 W) with Rome II criteria of functional abdominal bloating and gas-related symptoms were included in a pilot study. In all cases, the presence of malabsorption of both lactose (20 g) and fructose plus sorbitol (20+3.5 g) was assessed by means of hydrogen breath test. Patients with sugar malabsorption were put on a malabsorbed sugar-free diet. Follow-up visits were scheduled at both 1 and 12 months after starting the diet. Global rating scales of change as compared to the beginning of the study were used to assess symptom changes.


RESULTS
Twenty-six of 36 patients (72.2%) presented sugar malabsorption (six lactose, 12 fructose plus sorbitol, and eight both). Seventeen of the 26 (65%) patients with malabsorption had symptoms of sugar intolerance during the 3-h breath testing period. All 26 were put on malabsorbed sugar-free diets. Eighty-one per cent of patients referred clinical improvement at 1-month visit, which was maintained at 12 months in 67% of them (complete improvement in 50% and partial improvement in 16.7%).


CONCLUSIONS
Sugar malabsorption and intolerance seem to be frequent in patients with functional abdominal bloating and gas-related complaints. A malabsorbed sugar-free diet might be a long-term effective therapy in a high percentage of patients. Further controlled clinical trials are warranted.
Fernández-Bañares
Fernando
F
Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona, Spain. digestiu@mutuaterrassa.es
Rosinach
Mercé
M
Esteve
Maria
M
Forné
Montserrat
M
Espinós
Jorge C
JC
Maria Viver
Josep
J
D001944:Breath Tests; D003109:Colonic Diseases, Functional / Q000178:diet therapy* / Q000209:etiology / Q000378:metabolism; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism*; D005260:Female; D005414:Flatulence / Q000178:diet therapy* / Q000209:etiology / Q000378:metabolism; D005632:Fructose / Q000008:administration & dosage / Q000378:metabolism; D006801:Humans; D007408:Intestinal Absorption; D007785:Lactose / Q000008:administration & dosage / Q000378:metabolism; D007787:Lactose Intolerance / Q000178:diet therapy / Q000209:etiology / Q000378:metabolism; D008286:Malabsorption Syndromes / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013012:Sorbitol / Q000008:administration & dosage / Q000378:metabolism; D016896:Treatment Outcome
D004040:Dietary Carbohydrates; D005632:Fructose; D013012:Sorbitol; D007785:Lactose