So Sweet It Hurts: Fructose and Chronic Abdominal Pain

Consider fructose intolerance in children with chronic abdominal pain, after you have ruled out more serious GI disorders such as Crohn disease and ulcerative colitis. A low-fructose diet can be an effective treatment, according to the results of a recent study reported at the ACG 2010 Annual Scientific Meeting.

The study included a total of 245 patients aged 2 to 18 years (median age, 11) who had unexplained chronic abdominal pain. Breath hydrogen tests revealed fructose intolerance in 132 of the participants, and a low-fructose diet was prescribed for them. Symptoms resolved in 88 (67.7%) of the 132 patients.

Fructose intolerance is typically a diagnosis of exclusion, according to study investigators Daniel Lustig, MD, and Bisher Abdullah, MD, of Mary Bridge Children's Hospital in Tacoma, Wash. Once other GI disorders are ruled out, a breath hydrogen test is administered. A breath hydrogen level that is more than 20 points above baseline points to fructose intolerance.

"With fructose in so many foods, ranging from apples to packaged foods with the widespread use of high-fructose corn syrup, it is difficult to avoid," said Dr Lustig. He added that fructose intolerance seems to be more common in teenage girls with chronic abdominal pain.

But, he continued, the good news is that symptoms resolve in more than half of patients who adhere to a low-fructose diet.