Introduction
Substrate | Gas Reading | Diagnostic Criteria for Malabsorption | Proportion of Malabsorption | Reference |
---|---|---|---|---|
Fructose breath tests | ||||
Fructose (A. 15 g fructose in 150 cc water; B. 25 g fructose in 250 cc water; C. 50 g fructose in 500 cc water; D. 50 g fructose in 125 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen, methane, or both; or successive rise of ≥ 5 ppm over baseline in 3 consecutive readings. Test duration of 4–6 h | 0% (A), 10% (B), 80% (C), and 60% (D) in healthy patients (n = 20 each) | Rao et al., 2007 [20] |
Fructose (50 g fructose) | Hydrogen and methane | Hydrogen levels ≥ 20 ppm; methane levels ≥ 12 ppm; or sum of combined peaks ≥ 15 ppm. Test duration of 2–4 h | 55% in IBS patients (n = 94), and 65% in IBS patients on fructose-reduced diet (n = 88) | Berg et al., 2013 [21] |
Fructose (25 g fructose in 200 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 16% in lactose intolerant patients (n = 279) | Schnedl et al., 2020 [22] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2.5 h | 55% in patients with abdominal symptoms (n = 222) | Escobar et al., 2014 [23] |
Fructose (35 g in 300 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane twice in succession. Test duration of 5 h | 45% in functional gastrointestinal disease patients (n = 1372) | Wilder-Smith et al., 2013 [24] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 35% in pediatric patients with gastrointestinal symptoms (n = 323) | Kwiecień et al., 2021 [25] |
Fructose (35 g fructose in 300 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane. Test duration of 5 h | 27% in functional gastrointestinal disease patients (n = 30) | Wilder-Smith et al., 2021 [26] |
Fructose (A. 50 g fructose, B. 25 g fructose) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 58% (A) and 19% (B) in healthy patients (n = 21) | Truswell et al., 1988 [27] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 30% in pediatric patients with chronic abdominal pain (n = 118) | Posovszky et al., 2019 [28] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; rise of ≥ 5 to ≥ 12 ppm methane; or ≥ 10 to ≥ 15 ppm for hydrogen-plus-methane. Test duration of 3 h | 50% in pediatric patient with abdominal symptoms (n = 54) | Hammer et al., 2021 [29] |
Fructose (1 g/kg fructose up to maximum of 25 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 10 ppm over baseline methane. Test duration of 3 h | 60% (by hydrogen), 35% (by methane) in pediatric patients with abdominal symptoms (n = 187) | Schneider et al., 2020 [30] |
Fructose (40 g fructose in 330 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 65% in healthy patients (n = 20), 70% in IBS patients (n = 30) | Skoog et al., 2008 [31] |
Fructose (1 g/kg fructose up to maximum of 50 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h (symptoms monitored for 24 h) | 68% in patients with abdominal pain (n = 31) | Ozaki et al., 2018 [32] |
Fructose (A. 50 g fructose in 150 cc water, B. 50 g fructose in 250 cc water, C. 25 g in 250 cc water) | Hydrogen and methane | Rise of ≥ 3 ppm over 3 consecutive breath samples from baseline; or ≥ 20 ppm over baseline hydrogen and/or methane. Test duration of | 74% (A, n = 203), 70% (B, n = 33), 39% (C, n = 36) in patients with abdominal symptoms | Choi et al., 2003 [33] |
Fructose (1 g/kg fructose up to maximum of 50 g) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen and/or methane. Test duration of 5 h | 59% in healthy pediatic patients (n = 34), 41% in pediatric patients with functional abdominal pain (n = 71) | Martínez-Azcona et al., 2019 [34] |
Fructose (25 g fructose in 250 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 14% in healthy Thai patients (n = 77) | Densupsoontorn et al., 2007 [35] |
Fructose (2 g/kg fructose up to maximum of 50 g) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration not reported | 62% in pediatric patients with recurrent abdominal pain (n = 121) | Gijsbers et al., 2012 [36] |
Fructose (25 g fructose in 250 cc water) | Hydrogen and methane | Hydrogen and/or methane levels ≥ 20 ppm. Test duration of 5 h | 35% in IBS patients (n = 90) | Melchior et al., 2014 [37] |
Fructose (A. 1 g fructose, B. 15 g fructose, C. 45 g fructose in 240 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 0% (A, n = 9), 3% (B, n = 10), 62% (C, n = 13) in pediatric patients with abdominal pain | Gomara et al., 2008 [38] |
Fructose (50 g fructose in 250 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 75% in obese African American patients (n = 16), 43% in obese Hispanic patients (n = 21) | Walker et al., 2012 [39] |
Fructose (25 g fructose in 200 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 2 h | 24% in patients with abdominal symptoms (n = 341) | Enko et al., 2016 [40] |
Fructan breath tests | ||||
Fructan (10 g inulin dissolved in 100 cc water) | Hydrogen | Rise of ≥ 20 ppm over baseline hydrogen. Test duration of 3 h | 19% in IBS patients (n = 21), 5% in healthy patients | Gutierrez et al., 2016 [41] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 64% in IBS patients (n = 102) | Leelasinjaroen et al., 2017 [42] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 58.3% in IBS patients (n = 24) | Yu et al., 2014 [43] |
Fructan (10 g fructan dissolved in 100 cc water) | Hydrogen and methane | Rise of ≥ 20 ppm over baseline hydrogen; or ≥ 15 ppm over baseline methane. Test duration of 3 h | 77% in female IBS patients | Attaluri et al., 2009 [44] |
Methods
Study cohort
Fructose and fructan hydrogen breath testing
Data abstraction and analysis
Results
Patient cohort
Characteristics | All Patients (n = 186) | Patients Positive for Fructose HBT (n = 71) | Patients Negative for Fructose HBT (n = 115) | Patients Positive for Fructan HBT (n = 91) | Patients Negative for Fructan HBT (n = 95) | Patients Positive for Both HBTs (n = 42) | Patients Negative for Both HBTs (n = 66) |
---|---|---|---|---|---|---|---|
Age, median years (Q1-Q3) | 36.7 (29.6–47.5) | 38.8 (29.8–51.2) | 34.8 (28.5–43.6) | 37.6 (29.8–47.2) | 34.8 (28.6–46.4) | 39.9 (29.8–52.3) | 34.0 (28.0–43.5) |
Male, n (%) | 70 (37.6) | 26 (36.6) | 43 (37.4%) | 30 (33.0%) | 41 (43.2%) | 17 (40.5%) | 29 (43.9%) |
Symptoms, n (%) | |||||||
Bloating | 133 (71.5%) | 47 (66.2%) | 86 (74.8%) | 68 (74.7%) | 65 (68.4%) | 27 (67.3%) | 45 (68.2%) |
Abdominal Pain | 118 (63.4%) | 40 (56.3%) | 78 (67.8%) | 58 (63.7%) | 60 (63.2%) | 23 (54.8%) | 43 (65.2%) |
Diarrhea | 79 (42.5%) | 30 (42.3%) | 49 (42.6%) | 39 (42.9%) | 40 (42.1%) | 19 (45.2%) | 29 (43.9%) |
Constipation | 48 (25.8%) | 19 (26.8%) | 29 (25.2%) | 27 (29.7%) | 21 (22.1%) | 13 (31.0%) | 15 (22.7%) |
Increased Flatulence | 28 (15.1%) | 11 (15.5%) | 17 (14.8%) | 11 (12.1%) | 17 (17.9%) | 5 (11.9%) | 11 (16.7%) |
Nausea | 29 (15.6%) | 11 (15.5%) | 18 (15.7%) | 19 (20.9%) | 10 (10.5%) | 7 (16.7%) | 6 (9.1%) |
Acid Reflux | 23 (12.4%) | 5 (7.0%) | 18 (15.7%) | 10 (11.0%) | 13 (13.7%) | 0 (0.00%) | 8 (12.1%) |
Fecal Urgency | 25 (13.4%) | 9 (12.7%) | 16 (13.9%) | 14 (15.4%) | 11 (11.6%) | 7 (16.7%) | 9 (13.6%) |
Weight Loss | 12 (6.5%) | 4 (5.6%) | 8 (7.0%) | 6 (6.6%) | 6 (6.3%) | 1 (2.4%) | 3 (4.6%) |
Vomiting | 8 (4.3%) | 4 (5.6%) | 4 (3.5%) | 5 (5.5%) | 3 (3.2%) | 3 (7.1%) | 2 (3.0%) |
Appetite Loss | 9 (4.8%) | 4 (5.6%) | 5 (4.4%) | 3 (3.3%) | 6 (6.3%) | 1 (2.4%) | 3 (4.6%) |
Nonspecific Extraintestinal Complaints | 36 (19.4%) | 12 (16.9%) | 25 (20.9%) | 13 (14.3%) | 23 (24.2%) | 5 (11.9%) | 16 (24.2%) |