HCPLive Network

Want to Stop Abdominal Pain? Toss Out the Sweets

Placing children with recurrent or functional abdominal pain on low fructose diets may help improve their condition, according to research presented at the College of Gastroenterology’s 75th Annual Scientific meeting.

The study, “Fructose Intolerance/Malabsorption and Recurrent Abdominal Pain in Children,” investigated a total of 245 patients with unexplained chronic abdominal pain alone or associated with constipation, gas or bloating and/or diarrhea. Of the participants, 150 were female (62.1%) – who ranged in age from 2 to 18, with a median age of 11.
 
Fructose intolerance, or fructose malabsorption, is common in children with recurrent or functional abdominal pain and is typically diagnosed by exclusion, according to researchers Daniel Lustig, M.D. and Bisher Abdullah, M.D., pediatric gastroenterologists with the Mary Bridge Children's Hospital and Health Center in Tacoma, WA.
 
The researchers explained that once other GI conditions like Crohn's disease and ulcerative colitis are ruled out, a breath hydrogen test (BHT) is given to the patient. If the patient's breath hydrogen exceeds 20 points above baseline, then the patient is likely fructose intolerant.
 
BHT for fructose was performed in all patients in the study and it was positive for fructose intolerance in 132 of 245 patients (53.9%). A total of 113 of 245 (46.1%) of patients had a negative BHT for fructose intolerance. All of the 132 patients with a positive BHT for fructose had a nutritional consult with a registered dietician and were placed on a low%u2010fructose diet. Using a standard pain scale for children, 88 of the 132 patients (67.7%) reported resolution of symptoms on a low-fructose diet.
 
“With fructose in so many foods, ranging from apples to packaged foods with the wide-spread use of high fructose corn syrup, it is difficult to avoid, so the challenge is finding those foods with low fructose and still maintain a healthy nutritional balance that patients will adhere to,” said Dr. Lustig, in a press release, “especially teenagers.” He said fructose intolerance seems to be more prevalent in teenage girls with chronic abdominal pain. In his practice, Dr. Lustig said he typically sees three or four teenage girls a week with either a new diagnosis of fructose intolerance or for follow-up.
 
“But the good news is that over half of patients who are fructose intolerant and are able to maintain a low-fructose diet will notice an immediate improvement in their symptoms,” Dr. Lustig said.
 
Founded in 1932, the American College of Gastroenterology is an organization with an international membership of more than 11,000 individuals from 80 countries.
 
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Will you begin reducing fructose intake for your pediatric patients with recurrent or functional abdominal pain?

Further Reading
A brief look at several noteworthy studies and articles addressing key issues in the diagnosis and management of pain in children.
Fear avoidance contributes to disability and pain in children with functional abdominal pain but not inflammatory bowel disease, according to a study presented at the annual meeting of the American Psychosomatic Society.
Both children with persistent abdominal pain and their parents still benefit from a short social learning and cognitive behavioral therapy intervention a year later, according to a study published online Dec. 31 in JAMA Pediatrics.
The goal of IBS management should be to improve overall symptoms, including altered stool frequency and consistency, abdominal pain and discomfort, bloating, and quality of life.
Two pediatric surgeons describe a stepwise approach to treating children whose abdominal pain goes beyond a minor problem.
Abdominal pain and headache are the top conditions that receive further investigation with the use of CT.
The majority of children presenting to primary care with abdominal pain develop chronic abdominal pain, with a median duration of 7.5 months.
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