Background and Aims: Patients with chronic inflammatory bowel disease (IBD) might have a higher prevalence of fructose malabsorption than healthy controls. This study’s aim was to determine the prevalence and symptom severity of fructose malabsorption in patients with active and inactive IBD. Methods: The present study was a multicenter noninterventional diagnostic pilot trial. Two hundred fifty-one participants were recruited from 12 outpatient clinics for internal medicine across Germany and from the University of Kiel. Fructose malabsorption was diagnosed by hydrogen breath testing. Patients diagnosed with bacterial overgrowth, non-H2 producers, and patients who were tested positive for lactose malabsorption were excluded. Gastrointestinal symptoms during breath testing were evaluated using four-point subjective items to determine severity of bloating, abdominal pain, and diarrhea. Results: Two hundred five patients (45 with active IBD, 80 with IBD in remission, and 81 healthy controls) were analyzed. The number of patients diagnosed with fructose malabsorption – 35/44 (79.6%) in patients with active IBD, 59/80 (73.8%) inactive IBD, and 66/81 (81.5%) in healthy controls – did not differ between the groups (χ2 [2, N = 205] = 1.48, p = 0.48). However, abdominal pain was more frequent in patients with active IBD than patients with IBD in remission (z = −2.936, p = 0.010), and diarrhea was more frequent in patients with active IBD than in healthy controls (z = 2.489, p = 0.038). Conclusions: Fructose malabsorption is not more common among patients with IBD than healthy subjects. However, the greater prevalence of patient-reported symptoms among patients with IBD may be of pathological and therapeutic relevance.

1.
Ng
SC
,
Shi
HY
,
Hamidi
N
,
Underwood
FE
,
Tang
W
,
Benchimol
EI
,
.
Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies
.
Lancet
.
2017
;
390
(
10114
):
2769
78
.
2.
Zhang
YZ
,
Li
YY
.
Inflammatory bowel disease: pathogenesis
.
World J Gastroenterol
.
2014 Jan 7
;
20
(
1
):
91
9
.
3.
Choi
YK
,
Johlin
FC
Jr
,
Summers
RW
,
Jackson
M
,
Rao
SS
.
Fructose intolerance: an under-recognized problem
.
Am J Gastroenterol
.
2003 Jun
;
98
(
6
):
1348
53
.
4.
Barrett
JS
,
Irving
PM
,
Shepherd
SJ
,
Muir
JG
,
Gibson
PR
.
Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders
.
Aliment Pharmacol Ther
.
2009 Jul 1
;
30
(
2
):
165
74
.
5.
Helwig
U
,
Koch
AK
,
Koppka
N
,
Holtmann
S
,
Langhorst
J
.
The predictive value of the hydrogen breath test in the diagnosis of fructose malabsorption
.
Digestion
.
2019
;
99
(
2
):
140
7
.
6.
Murray
K
,
Wilkinson-Smith
V
,
Hoad
C
,
Costigan
C
,
Cox
E
,
Lam
C
,
.
Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI
.
Am J Gastroenterol
.
2014 Jan
;
109
(
1
):
110
9
.
7.
Misselwitz
B
,
Fox
M
.
The fructose hydrogen breath test: nothing behind the sweet fog
.
Digestion
.
2019
;
99
(
3
):
191
3
.
8.
Halpin
SJ
,
Ford
AC
.
Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis
.
Am J Gastroenterol
.
2012 Oct
;
107
(
10
):
1474
82
.
9.
Minderhoud
IM
,
Oldenburg
B
,
Wismeijer
JA
,
van Berge Henegouwen
GP
,
Smout
AJ
.
IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior
.
Dig Dis Sci
.
2004 Mar
;
49
(
3
):
469
74
.
10.
Vermeulen
W
,
De Man
JG
,
Pelckmans
PA
,
De Winter
BY
.
Neuroanatomy of lower gastrointestinal pain disorders
.
World J Gastroenterol
.
2014 Jan 28
;
20
(
4
):
1005
20
.
11.
Grover
M
,
Herfarth
H
,
Drossman
DA
.
The functional-organic dichotomy: postinfectious irritable bowel syndrome and inflammatory bowel disease-irritable bowel syndrome
.
Clin Gastroenterol Hepatol
.
2009 Jan
;
7
(
1
):
48
53
.
12.
Spiller
R
,
Garsed
K
.
Postinfectious irritable bowel syndrome
.
Gastroenterology
.
2009 May
;
136
(
6
):
1979
88
.
13.
Ferraris
RP
.
Dietary and developmental regulation of intestinal sugar transport
.
Biochem J
.
2001 Dec 1
;
360
(
Pt 2
):
265
76
.
14.
García-Herrera
J
,
Abad
B
,
Rodríguez-Yoldi
MJ
.
Effect of lipopolysaccharide on D-fructose transport across rabbit jejunum
.
Inflamm Res
.
2003 Apr
;
52
(
4
):
177
84
.
15.
García-Herrera
J
,
Navarro
MA
,
Marca
MC
,
de la Osada
J
,
Rodríguez-Yoldi
MJ
.
The effect of tumor necrosis factor-alpha on D-fructose intestinal transport in rabbits
.
Cytokine
.
2004 Jan 7
;
25
(
1
):
21
30
.
16.
Gionchetti
P
,
Dignass
A
,
Danese
S
,
Magro Dias
FJ
,
Rogler
G
,
Lakatos
PL
,
.
3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations
.
J Crohns Colitis
.
2017 Feb
;
11
(
2
):
135
49
.
17.
Gomollón
F
,
Dignass
A
,
Annese
V
,
Tilg
H
,
Van Assche
G
,
Lindsay
JO
,
.
3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management
.
J Crohns Colitis
.
2017 Jan
;
11
(
1
):
3
25
.
18.
Dignass
A
,
Lindsay
JO
,
Sturm
A
,
Windsor
A
,
Colombel
JF
,
Allez
M
,
.
Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management
.
J Crohns Colitis
.
2017 Jul 1
;
6
(
10
):
991
1030
.
19.
Magro
F
,
Gionchetti
P
,
Eliakim
R
,
Ardizzone
S
,
Armuzzi
A
,
Barreiro-de Acosta
M
,
.
Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders
.
J Crohns Colitis
.
2017 Jun 1
;
11
(
6
):
649
70
.
20.
Frieling
T
,
Kuhlbusch-Zicklam
R
,
Kalde
S
,
Heise
J
,
Hülsdonk
A
,
Kreysel
C
.
Fructose malabsorption: how much fructose can a healthy subject tolerate
.
Digestion
.
2011
;
84
(
4
):
269
72
.
21.
Rao
SS
,
Attaluri
A
,
Anderson
L
,
Stumbo
P
.
Ability of the normal human small intestine to absorb fructose: evaluation by breath testing
.
Clin Gastroenterol Hepatol
.
2007 Aug
;
5
(
8
):
959
63
.
22.
Goldstein
R
,
Braverman
D
,
Stankiewicz
H
.
Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints
.
Isr Med Assoc J
.
2000 Aug
;
2
(
8
):
583
7
.
23.
Goebel-Stengel
M
,
Monnikes
H
.
Optimal testing for diagnosis of fructose malabsorption: under-dosage leads to false negative intolerance test
.
J Neurogastroenterol Motil
.
2015 Mar 30
;
21
(
2
):
296
7
.
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