Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
Eur J Pediatr. 2019 Sep;178(9):1395-1403. doi: 10.1007/s00431-019-03418-4. Epub 2019 Jul 19.
The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%-76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%-53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice. What is Known: • Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking. • Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain. What is New: • Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children. • Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.
这项前瞻性队列研究的目的是比较功能性慢性腹痛患者和健康儿童的果糖吸收不良。样本分为两组：根据罗马 IV 标准无症状的儿童和以疼痛为主的功能性胃肠疾病。所有儿童均接受标准化呼气氢试验检测果糖吸收不良。测量氢气和甲烷，当氢气超过基线 20 ppm 以上时，试验被认为是阳性。如果阳性，患者给予低果糖饮食，并评估反应。共纳入 105 例儿童（34 例健康儿童，71 例功能性慢性腹痛），两组儿童的人口统计学特征相似（35.2%为男性，年龄 9.5 ± 2.8 岁）。通过氢呼气试验检测呼气中的氢水平，结果显示 58.8%的健康儿童（95%CI 40.8%-76.8%）和 40.8%的慢性腹痛儿童（95%CI 28.7%-53.0%）存在果糖吸收不良，排除细菌过度生长的儿童。31 例有症状且试验阳性的患儿中，21 例（72.4%）在低果糖饮食后症状改善。结论：无症状儿童果糖吸收不良较慢性腹痛儿童更为常见。在临床实践中使用该试验前，需要更好的标准化试验条件以提高诊断准确性。已知：• 虽然果糖吸收不良被认为与慢性腹痛有关，但缺乏高质量证据。• 人们对在慢性腹痛儿童中使用氢呼气试验检测果糖吸收不良提出了担忧。新发现：• 以疼痛为主的功能性胃肠疾病患儿的果糖吸收不良并不比无症状儿童更为常见。• 低果糖饮食后症状改善可能表明，尽管以疼痛为主的功能性胃肠疾病患者的吸收不良百分比没有更高，但他们对果糖的不耐受程度更大。
