Choi Young K, Johlin Fredrick C, Summers Robert W, Jackson Michelle, Rao Satish S C
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Am J Gastroenterol. 2003 Jun;98(6):1348-53. doi: 10.1111/j.1572-0241.2003.07476.x.
Although the role of lactose intolerance in the pathogenesis of abdominal symptoms is well known, the role of fructose intolerance is unclear. Our aims were 1) to examine the prevalence of fructose intolerance in patients with unexplained abdominal symptoms, and 2) to explore whether fructose concentration influences fructose breath test.
Over 2 yr, patients with unexplained symptoms answered questionnaires and underwent fructose breath tests. Patients received 50 g fructose in 150 ml water (33% solution). Breath samples were collected for hydrogen and methane. In a second study, breath test was performed after giving either 10%, 20%, or 33% fructose solution. Data were analyzed retrospectively.
A total of 183 patients (50 male, 133 female) had breath tests, of whom 134 (73%) were positive. Among these, 119 (89%) had elevated H(2), and 15 (11%) had elevated CH(4) or both gases. Questionnaires showed that flatus (83%), pain (80%), bloating (78%), belching (70%), and altered bowel habit (65%) were the most common symptoms. Breath test reproduced symptoms in 101 patients (75%). In the second study, 14/36 (39%) tested positive with a 10% solution, 23/33 (70%) with a 20% solution, and 16/20 (80%) with a 33% solution (10% versus 20% or 33%, p < 0.01).
Fructose intolerance may cause unexplained GI symptoms. The higher yield of positive tests in our initial study may be due to referral bias or testing conditions; lower test dose produced a lower yield. Nonetheless, recognition and treatment of fructose intolerance may help many patients.
虽然乳糖不耐受在腹部症状发病机制中的作用已为人熟知，但果糖不耐受的作用尚不清楚。我们的目的是：1）研究不明原因腹部症状患者中果糖不耐受的患病率；2）探讨果糖浓度是否会影响果糖呼气试验。
在两年多的时间里，有不明原因症状的患者填写问卷并接受果糖呼气试验。患者饮用含50克果糖的150毫升水（33%溶液）。收集呼气样本检测氢气和甲烷。在第二项研究中，给予10%、20%或33%的果糖溶液后进行呼气试验。对数据进行回顾性分析。
共有183例患者（50例男性，133例女性）接受了呼气试验，其中134例（73%）结果为阳性。在这些阳性患者中，119例（89%）氢气升高，15例（11%）甲烷升高或两种气体均升高。问卷显示，肠胃胀气（83%）、疼痛（80%）、腹胀（78%）、嗳气（70%）和排便习惯改变（65%）是最常见的症状。呼气试验使101例患者（75%）出现症状。在第二项研究中，10%溶液组36例中有14例（39%）检测为阳性，20%溶液组33例中有23例（70%）检测为阳性，33%溶液组20例中有16例（80%）检测为阳性（10%溶液组与20%或33%溶液组相比，p<0.01）。
果糖不耐受可能导致不明原因的胃肠道症状。我们初始研究中较高的阳性检测率可能是由于转诊偏倚或检测条件所致；较低剂量检测的阳性率较低。尽管如此，识别和治疗果糖不耐受可能会帮助许多患者。
