Dataset Information

Dietary exclusion of fructose and lactose after positive breath tests improved rapid-transit constipation in children.

ABSTRACT:

Aims

Exclusion of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is effective in alleviating symptoms of irritable bowel syndrome (IBS) in adults. Rapid-transit constipation (RTC) is a recently discovered subset of chronic constipation and has been linked to food intolerance. The aim of this study was to audit the effect of specific FODMAP elimination diets in children with RTC.

Methods

This was an audit of children presenting to a tertiary children's hospital surgeon with refractory chronic constipation who had rapid transit in the proximal colon on nuclear imaging; had hydrogen/methane breath tests for fructose, lactose, and/or sorbitol intolerance; and were advised to exclude positive sugar under clinical supervision. Patients filled in a questionnaire rating severity of constipation, abdominal pain, and pain on defecation with a visual analogue scale (VAS, 0?=?none, 10?=?high) and stool consistency for 6 months before and after dietary exclusion.

Results

In responses from 29 children (5-15?years, 21 males), 70% eliminated fructose, and 40% eliminated lactose. There was a significant reduction in the severity of constipation (VAS mean?±?SEM, pre 5.8?±?0.5 vs post 3.3?±?0.6, P?vs 2.8?±?0.5, P?=?0.0004), pain on defecation (5.8?±?0.6 vs 2.6?±?0.5, P?vs post 3.9?±?0.2, P?=?0.004).

Conclusion

Children with RTC showed significant improvements in constipation and pain after excluding the sugar indicated by positive breath tests, suggesting that specific sugar-exclusion diets may have a role in the management of RTC in children.

SUBMITTER: Waingankar K

PROVIDER: S-EPMC6308069 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

Dietary exclusion of fructose and lactose after positive breath tests improved rapid-transit constipation in children.

Waingankar Kasturi K Lai Christoper C Punwani Vishal V Wong Jeremy J Hutson John M JM Southwell Bridget R BR

JGH open : an open access journal of gastroenterology and hepatology 20180814 6

<h4>Aims</h4>Exclusion of <i>f</i>ermentable <i>o</i>ligosaccharides, <i>d</i>isaccharides, <i>m</i>onosaccharides, and <i>p</i>olyols (FODMAPs) from the diet is effective in alleviating symptoms of irritable bowel syndrome (IBS) in adults. Rapid-transit constipation (RTC) is a recently discovered subset of chronic constipation and has been linked to food intolerance. The aim of this study was to audit the effect of specific FODMAP elimination diets in children with RTC.<h4>Methods</h4>This was ...[more]

PMID: 30619935

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Project description:BackgroundAdult lactase non-persistence (LNP) is due to low lactase expression, resulting in lactose malabsorption (LM). LNP is a genetic trait, but is typically determined by LM markers including breath H2, blood glucose, and urinary galactose after a lactose tolerance test. Known validity of these markers using milk is limited, despite being common practice. Compositional variation, such as ?-casein variants, in milk may impact diagnostic efficacy. This study aimed to evaluate the diagnostic accuracy to detect LNP using these commonly measured LM markers after both lactose and milk challenges.MethodsFourty healthy young women were challenged with 50?g lactose then randomized for separate cross-over visits to ingest 750?mL milk (37.5?g lactose) as conventional (both A1 and A2 ?-casein) and A1 ?-casein-free (a2 Milk™) milk. Blood, breath and urine were collected prior to and up to 3?h following each challenge. The presence of C/T13910 and G/A22018 polymorphisms, determined by restriction fragment length polymorphism, was used as the diagnostic reference for LNP.ResultsGenetic testing identified 14 out of 40 subjects as having LNP (C/C13910 and G/G22018). All three LM markers (breath H2, plasma glucose and urinary galactose/creatinine) discriminated between lactase persistence (LP) and LNP following lactose challenge with an area under the receiver operating characteristic (ROC) curve (AUC) of 1.00, 0.75 and 0.73, respectively. Plasma glucose and urinary galactose/creatinine were unreliable (AUC?<?0.70) after milk ingestion. The specificity of breath H2 remained high (100%) when milk was used, but sensitivity was reduced with conventional (92.9%) and a2 Milk™ (78.6%) compared to lactose (sensitivities adjusted for lactose content). The breath H2 optimal cut-off value was lower with a2 Milk™ (13?ppm) than conventional milk (21?ppm). Using existing literature cut-off values the sensitivity and specificity of breath H2 was greater than plasma glucose to detect LNP following lactose challenge whereas values obtained for urinary galactose/creatinine were lower than the existing literature cut-offs.ConclusionThis study showed accurate diagnosis of LNP by breath H2 irrespective of the substrate used, although the diagnostic threshold may vary depending on the lactose substrate or the composition of the milk.Trial registrationACTRN12616001694404 . Registered prospectively on December 9, 2016.

Dataset Information

Dietary exclusion of fructose and lactose after positive breath tests improved rapid-transit constipation in children.

Aims

Methods

Results

Conclusion

Publications

Dietary exclusion of fructose and lactose after positive breath tests improved rapid-transit constipation in children.

Similar Datasets

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