Carbohydrate intolerance in patients with self-reported food hypersensitivity: comparison of lactulose and glucose.

Abstract:

OBJECTIVE:Malabsorption of low-digestible carbohydrates is physiological, but poorly tolerated in some patients. We investigated symptom anticipation and microbial fermentation as possible mechanisms of carbohydrate intolerance in patients with self-reported food hypersensitivity. MATERIAL AND METHODS:In a randomized, double-blind, cross-over study, 27 consecutive patients with unexplained, self-reported food hypersensitivity were given 10 g lactulose and 10 g glucose (placebo). Symptoms and pulmonary excretion of hydrogen and methane were assessed. Short-chain fatty acids (SCFAs), lactate and prostaglandin E(2) (PGE(2)) were analyzed in rectal dialysis fluid, and compared to dialysates from nine healthy volunteers. RESULTS:Post-lactulose symptom scores were correlated with habitual symptom scores (r = 0.6, p = 0.001), significantly higher than post-glucose symptom scores (p = 0.01) and significantly higher in patients than controls (p = 0.0007). Levels of SCFAs, lactate and PGE(2) in rectal dialysates were not significantly different after lactulose and glucose, or between patients and controls. Hydrogen excretion was not correlated with symptom scores. CONCLUSIONS:The findings suggest that self-reported food hypersensitivity is related to microbial fermentation of malabsorbed carbohydrates and not to symptom anticipation solely. Levels of SCFAs, lactate and PGE(2) in rectal dialysates could not explain the fermentation-associated hypersensitivity.

journal_name

Scand J Gastroenterol

authors

Valeur J,Morken MH,Norin E,Midtvedt T,Berstad A

doi

10.3109/00365520903348684

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

1416-23

issue

12

eissn

0036-5521

issn

1502-7708

pii

10.3109/00365520903348684

journal_volume

44

pub_type

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