Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders

Aliment Pharmacol Ther. 2009 Jul 1;30(2):165-74. doi: 10.1111/j.1365-2036.2009.04018.x. Epub 2009 Apr 15.


Background: Fructose malabsorption, lactose malabsorption and an early rise in breath hydrogen after lactulose (ERBHAL) may play roles in induction of symptoms in gastrointestinal conditions.

Aim: To compare prevalence and interactions of fructose malabsorption, lactose malabsorption and ERBHAL among healthy subjects and those with chronic intestinal disorders using consistent breath hydrogen testing methodologies.

Methods: Consecutive series of Caucasian patients with Crohn's disease (n = 91), ulcerative colitis (56), functional gastrointestinal disorders (FGID) (201), coeliac disease (136) and 71 healthy volunteers underwent breath hydrogen testing using lactulose, fructose and lactose.

Results: Early rise in breath hydrogen after lactulose occurred more commonly in healthy controls (39%) than in Crohn's disease (20%) and untreated coeliac disease (14%; P < 0.008), but not FGID (27%), ulcerative colitis (26%) or treated coeliac disease (29%). Fructose malabsorption was more frequent in Crohn's disease (61%) than other groups (33-44%, P < 0.05). Lactose malabsorption was most common in Crohn's disease (42%) and ulcerative colitis (40%) and uncommon (10%) in 79 patients with newly diagnosed coeliac disease. In Crohn's disease, concurrent Fructose malabsorption and lactose malabsorption was most common (29%), and the association of fructose malabsorption with ERBHAL seen overall (62%) was not observed (36%, P < 0.0001).

Conclusions: Carbohydrate malabsorption and ERBHAL are normal physiological phenomena. The abnormal patterns observed in Crohn's disease may have pathogenic importance.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Breath Tests / methods
  • Case-Control Studies
  • Chronic Disease
  • Female
  • Fructose / adverse effects*
  • Humans
  • Hydrogen
  • Inflammatory Bowel Diseases / complications*
  • Lactose Intolerance / complications*
  • Lactose Intolerance / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Sex Factors


  • Fructose
  • Hydrogen