title: Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI.
abstract: OBJECTIVE
  The objective of this study was to investigate whether ingestion of fructose and fructans (such as inulin) can exacerbate irritable bowel syndrome (IBS) symptoms. The aim was to better understand the origin of these symptoms by magnetic resonance imaging (MRI) of the gut.
  
  
  METHODS
  A total of 16 healthy volunteers participated in a four-way, randomized, single-blind, crossover study in which they consumed 500 ml of water containing 40 g of either glucose, fructose, inulin, or a 1:1 mixture of 40 g glucose and 40 g fructose. MRI scans were performed hourly for 5 h, assessing the volume of gastric contents, small bowel water content (SBWC), and colonic gas. Breath hydrogen (H2) was measured and symptoms recorded after each scan.
  
  
  RESULTS
  Data are reported as mean (s.d.) (95% CI) when normally distributed and median (range) when not. Fructose increased area under the curve (AUC) from 0-5 h of SBWC to 71 (23) l/min, significantly greater than for glucose at 36 (11-132) l/min (P<0.001), whereas AUC SBWC after inulin, 33 (17-106) l/min, was no different from that after glucose. Adding glucose to fructose decreased AUC SBWC to 55 (28) l/min (P=0.08) vs. fructose. Inulin substantially increased AUC colonic gas to 33 (20) l/min, significantly greater than glucose and glucose+fructose (both P<0.05). Breath H2 rose more with inulin than with fructose. Glucose when combined with fructose significantly reduced breath H2 by 7,700 (3,121-12,300) p.p.m./min relative to fructose alone (P<0.01, n=13).
  
  
  CONCLUSIONS
  Fructose but not inulin distends the small bowel with water. Adding glucose to fructose reduces the effect of fructose on SBWC and breath hydrogen. Inulin distends the colon with gas more than fructose, but causes few symptoms in healthy volunteers.
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Murray
authors.affiliation: Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Wilkinson-Smith
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hoad
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Costigan
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Cox
authors.affiliation: Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: Ching
authors.initials: C
authors.lastname: Lam
authors.affiliation: Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: Luca
authors.initials: L
authors.lastname: Marciani
authors.affiliation: Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Gowland
authors.affiliation: Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
authors.forename: Robin C
authors.initials: RC
authors.lastname: Spiller
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001944:Breath Tests / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005630:Fructans / Q000494:pharmacology*; D005632:Fructose / Q000494:pharmacology*; D005766:Gastrointestinal Contents / Q000187:drug effects; D005947:Glucose / Q000494:pharmacology*; D064368:Healthy Volunteers; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D007408:Intestinal Absorption / Q000187:drug effects; D007420:Intestine, Large / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D007421:Intestine, Small / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D007444:Inulin; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012107:Research Design; D016037:Single-Blind Method; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D005630:Fructans; D005632:Fructose; D006859:Hydrogen; D007444:Inulin; D005947:Glucose