Sugar malabsorption in functional abdominal bloating: A pilot study on the long-term effect of dietary treatment



      Functional abdominal bloating is a functional bowel disorder dominated by a feeling of abdominal fullness without sufficient criteria for another functional gastrointestinal disorder. Gas-related complaints (i.e., passage of flatus), which are present in a subgroup of these patients, might be associated with carbohydrate malabsorption.


      To evaluate the presence of lactose and/or fructose plus sorbitol malabsorption, and the long-term efficacy of malabsorbed sugar-free diets, in patients with Rome II criteria of functional abdominal bloating and gas-related symptoms.


      Thirty-six consecutive patients (age, 51±3.1 years; sex, 12 M, 24 W) with Rome II criteria of functional abdominal bloating and gas-related symptoms were included in a pilot study. In all cases, the presence of malabsorption of both lactose (20g) and fructose plus sorbitol (20+3.5g) was assessed by means of hydrogen breath test. Patients with sugar malabsorption were put on a malabsorbed sugar-free diet. Follow-up visits were scheduled at both 1 and 12 months after starting the diet. Global rating scales of change as compared to the beginning of the study were used to assess symptom changes.


      Twenty-six of 36 patients (72.2%) presented sugar malabsorption (six lactose, 12 fructose plus sorbitol, and eight both). Seventeen of the 26 (65%) patients with malabsorption had symptoms of sugar intolerance during the 3-h breath testing period. All 26 were put on malabsorbed sugar-free diets. Eighty-one per cent of patients referred clinical improvement at 1-month visit, which was maintained at 12 months in 67% of them (complete improvement in 50% and partial improvement in 16.7%).


      Sugar malabsorption and intolerance seem to be frequent in patients with functional abdominal bloating and gas-related complaints. A malabsorbed sugar-free diet might be a long-term effective therapy in a high percentage of patients. Further controlled clinical trials are warranted.


      To read this article in full you will need to make a payment
      Subscribe to Clinical Nutrition
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Thompson W.G.
        • Longstreth G.F.
        • Drossman D.A.
        • Heaton K.W.
        • Irvine E.J.
        • Müller-Lissner S.A.
        Functional bowel disorders and functional abdominal pain.
        Gut. 1999; 45: II43-II47
        • Lea R.
        • Whorwell P.J.
        Bloating, distension, and the irritable bowel syndrome.
        Medscape Gen Med. 2005; 7
        • Barbara G.
        • De Giorgio R.
        • Stanghellini V.
        • Cremon C.
        • Salvioli B.
        • Corinaldesi R.
        New pathophysiological mechanisms in irritable bowel syndrome.
        Aliment Pharmacol Ther. 1994; 20: 1-9
        • Salvioli B.
        • Serra J.
        • Azpiroz F.
        • et al.
        Origin of gas retention and symptoms in patients with bloating.
        Gastroenterology. 2005; 128: 574-579
        • Passos M.C.
        • Serra J.
        • Azpiroz F.
        • Tremolaterra F.
        • Malagelada J.R.
        Impaired reflex control of intestinal gas transit in patients with abdominal bloating.
        Gut. 2005; 54: 344-348
        • Levitt M.D.
        • Furne J.
        • Olsson S.
        The relation of passage of gas on abdominal bloating to colonic gas production.
        Ann Intern Med. 1996; 124: 422-424
        • Fleming S.C.
        Evaluation of a hand-held hydrogen monitor in the diagnosis of intestinal lactase deficiency.
        Ann Clin Biochem. 1990; 27: 499-500
        • Duan L.P.
        • Braden B.
        • Clement Th.
        • Caspary W.F.
        • Lembcke B.
        Clinical evaluation of a miniaturized desktop breath hydrogen analyser.
        Z Gastroenterol. 1994; 32: 575-578
        • Fernández-Bañares F.
        • Esteve-Pardo M.
        • de Leon R.
        • et al.
        Sugar malabsorption in functional bowel disease: clinical implications.
        Am J Gastroenterol. 1993; 88: 2044-2050
        • Fernández-Bañares F.
        Dieta controlada en lactosa.
        in: Salas J. Bonada A. Trallero R. Salò M.E. Nutrición y dietética clínica. Doyma Ediciones, Barcelona2000: 203-208
        • Velhuyzen van Zanten S.J.O.
        • Talley N.J.
        • Bytzer P.
        • Klein K.B.
        • Whorwell P.J.
        • Zinsmeister A.R.
        Design of treatment trials for the functional gastrointestinal disorders.
        in: Drossman D.A. Corazziari E. Talley N.J. Thompson W.G. Whitehead W.E. The functional gastrointestinal disorders: diagnosis, pathophysiology, and treatment. A multinational consensus. Degnon Associates, McLean, VA2000: 577-622
        • Kwon S.
        • Visco A.G.
        • Fitzgerald M.P.
        • Ye W.
        • Whitehead W.E.
        Pelvic floor disorders network. Validity and reliability of the modified Manchester health questionnaire in assessing patients with fecal incontinence.
        Dis Colon Rectum. 2005; 48: 323-331
        • Calvet X.
        • Bustamante E.
        • Montserrat A.
        • et al.
        Validation of phone interview for follow-up in clinical trials on dyspepsia: evaluation of the Glasgow dyspepsia severity score and a Likert-scale symptoms test.
        Eur J Gastroenterol Hepatol. 2000; 12: 949-953
        • Briet F.
        • Achour L.
        • Flourie B.
        • et al.
        Symptomatic response to varying levels of fructo-oligosaccharides consumed occasionally or regularly.
        Eur J Clin Nutr. 1995; 49: 501-507
        • Dapoigny M.
        • Stockbrügger R.W.
        • Azpiroz F.
        • et al.
        Role of alimentation in irritable bowel syndrome.
        Digestion. 2003; 67: 225-233
        • Burden S.
        Dietary treatment of irritable bowel syndrome: current evidence and guidelines for future practice.
        J Hum Nutr Diet. 2001; 14: 231-241
        • Symons P.
        • Jones M.P.
        • Kellow J.E.
        Symptom provocation in irritable bowel syndrome. Effects of differing doses of fructose–sorbitol.
        Scand J Gastroenterol. 1992; 27: 940-944
        • Vesa T.H.
        • Seppo L.M.
        • Marteau T.
        • Korpela R.A.
        • Sahi T.
        Role of irritable bowel síndrome in subjective lactose intolerance.
        Am J Clin Nutr. 1998; 67: 710-715
        • Nelis G.F.
        • Vermeeran M.A.P.
        • Jansen W.
        Role of fructose–sorbitol mixtures in the symptoms of the irritable bowel.
        Gastroenterology. 1990; 99: 1016-1020
        • Di Stefano M.
        • Strocchi A.
        • Malservisi G.
        • Veneto G.
        • Ferrieri A.
        • Corazza G.R.
        Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms.
        Aliment Pharmacol Ther. 2000; 14: 1001-1008
        • Kajs T.M.
        • Fitzgerald J.A.
        • Buckner R.Y.
        • Coyle G.A.
        • Stinson B.S.
        • Morel J.G.
        Influence of the methanogenic flora on the breath H2 and symptom response to ingestion of sorbitol or oat fiber.
        Am J Gastroenterol. 1997; 92: 89-94
        • Vernia P.
        • Camillo M.D.
        • Marinaro V.
        • Caprilli R.
        Effect of predominant methanogenic flora on the outcome of lactose breath test in irritable bowel syndrome patients.
        Eur J Clin Nutr. 2003; 57: 1116-1119
        • Di Stefano M.
        • Miceli E.
        • Armellini E.
        • Missanelli A.
        • Corazza G.R.
        Probiotics and functional abdominal bloating.
        J Clin Gastroenterol. 2004; 38: S102-S103
        • Niv E.
        • Naftali T.
        • Hallak R.
        • Vaisman N.
        The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome. A double blind, placebo-controlled, randomised study.
        Clin Nutr. 2005; 24: 925-931
        • Kajander K.
        • Hatakka K.
        • Poussa T.
        • et al.
        A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention.
        Aliment Pharmacol Ther. 2005; 22: 387-394
        • O’Mahony L.
        • McCarthy J.
        • Kelly P.
        • et al.
        Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles.
        Gastroenterology. 2005; 128: 541-551
        • 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; 2: 583-587
        • Ledochowski M.
        • Widner B.
        • Bair H.
        • Probst T.
        • Fuchs D.
        Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.
        Scand J Gastroenterol. 2000; 35: 1048-1052
        • Teuri U.
        • Vapaatalo H.
        • Korpela R.
        Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters.
        Am J Clin Nutr. 1999; 69: 973-979
        • Fernández-Bañares F.
        Dieta controlada en fructosa.
        in: Salas J. Bonada A. Trallero R. Saló M.E. Nutrición y dietética clínica. Doyma Ediciones, Barcelona2000: 209-214
        • Rumessen J.J.
        Fructose and related food carbohydrates.
        Scand J Gastroenterol. 1992; 27: 819-828
      1. Mattews RH, Pehrsson PR, Farhat-Sabet M. Sugar content of selected foods: individual and total sugars. US Department of Agriculture. Human Nutrition Information Service. Home Economics Research report no. 48, 1987.