J Neurogastroenterol Motil  
Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth
Kee Wook Jung,1 Myeognsook Seo,1 Young Hwan Cho,1 Young-Ok Park,2 So-Yoon Yoon,2 Jungbok Lee,3 Dong-Hoon Yang,1 In Ja Yoon,1 So Young Seo,1 Hyo Jeong Lee,1 Sang Hyoung Park,1 Kyung Jo Kim,1 Byong Duk Ye,1 Jeong-Sik Byeon,1 Hwoon-Yong Jung,1 Suk-Kyun Yang,1 Jin-Ho Kim,1 and Seung-Jae Myung1*
Departments of 1Gastroenterology, 2Clinical Nutrition, and 3Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to: Seung-Jae Myung, MD, PhD
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3917, Fax: +82-2-3010-0824, E-mail: sjmyung@amc.seoul.kr
Kee Wook Jung and Myeongsook Seo contributed equally to this article.
Received: March 20, 2017; Revised: September 7, 2017; Accepted: October 13, 2017; Published online: February 13, 2018.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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Abstract
Background/Aims
Fructose malabsorption (FM) mimics symptoms of irritable bowel syndrome (IBS), and its prevalence has increased. Diagnosing FM in IBS is challenging because of its overlap with small intestinal bacterial overgrowth (SIBO). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding SIBO using the glucose hydrogen breath test (HBT).
Methods
Patients diagnosed with IBS and asymptomatic control individuals were prospectively enrolled in the study. Dietary habits were determined using the Food Frequency Questionnaire. After excluding SIBO, participants were tested using both the 15 g and 25 g fructose HBTs.
Results
Thirty-five patients with IBS and 35 age- and sex-matched asymptomatic control individuals were enrolled. The 15 g fructose HBT was positive in 7 of the 35 (20.0%) patients with IBS and in 2 of 35 (5.7%) controls (P = 0.070). The 25 g fructose HBT was positive in 16 of the 35 (45.7%) patients with IBS and in 8 of the 35 (22.9%) controls (P = 0.040). Analysis of the Food Frequency Questionnaire responses showed no significant differences between the 2 groups in dietary intake, although patients with IBS showed a significantly higher mean fiber intake than controls (21.24 ± 11.35 g vs 15.87 ± 7.07 g, respectively, P = 0.040).
Conclusions
The 25 g fructose HBT identified FM in a significantly higher percentage of SIBO-negative patients with IBS than in asymptomatic control individuals, suggesting that FM may correlate with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of patients with IBS.
Keywords: Breath tests, Dietary therapy, Fructose, Irritable bowel syndrome


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