APT：果糖和乳糖不耐受及吸收不良检测

　　果糖和乳糖不耐受及吸收不良与不同功能性胃肠病症状之间的相关性仍不清楚。近日，瑞典的Wilder-Smith对果糖和乳糖不耐受及吸收不良进行了研究，并研究了其与功能性胃肠病中的临床胃肠道症状以及非临床胃肠道症状之间的相关性。另外，研究团队对饮食干预转归进行了评价。研究指出，果糖和乳糖不耐受在功能性胃肠病中常见，与非临床胃肠道症状增加相关，不过与特异性功能性胃肠病亚型不相关。Wilder-Smith教授的团队总结道：“呼吸试验中出现的症状，与功能性胃肠病的症状相关，但吸收不良与其不相关”。“饮食调整带来的有效症状缓解与吸收不良不相关”。“功能性胃肠病中果糖和乳糖所致的临床性胃肠道症状和非临床性胃肠道症状有关机制需要进一步的研究。”该文近日在线发表于《消化药理学和治疗学》（Aliment Pharmacol Ther）杂志上。

　　研究团队在一个单中心内采用呼吸检测证实了1372例功能性胃肠病患者的果糖和乳糖不耐受及吸收不良。结果与罗马Ⅲ标准下不同的功能性胃肠病亚组的临床症状相关。医师们评价了针对性减糖饮食6～8周后的作用。

　　各种功能性胃肠道疾病的果糖不耐受发生率为60%，乳糖为51%，二者均不耐受为33%。吸收不良的发生率分别为45%，32% 和16%。研究团队发现功能性胃肠病亚组间不耐受或吸收不良的发生率没有差异。功能性胃肠病症状与检测中诱发的症状相关，不过与吸收不良不相关。医师团队发现非临床胃肠道症状在不耐受的患者中更为常见。在几项截断值上甲烷呼吸水平与便秘没有相关性。研究团队注意到无论是否存在吸收不良，有80%的不耐受患者中达到充分的症状缓解。

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Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders.
BACKGROUND
The association of fructose and lactose intolerance and malabsorption with the symptoms of different functional gastrointestinal disorders (FGID) remains unclear.
AIM
To investigate the prevalence of fructose and lactose intolerance (symptom induction) and malabsorption and their association with clinical gastrointestinal (GI) as well as non-GI symptoms in FGID and the outcome of dietary intervention.
METHODS
Fructose and lactose intolerance (defined by positive symptom index) and malabsorption (defined by increased hydrogen/methane) were determined in 1372 FGID patients in a single centre using breath testing. Results were correlated with clinical symptoms in different FGID Rome III subgroups. The effectiveness of a targeted saccharide-reduced diet was assessed after 6-8 weeks.
RESULTS
Intolerance prevalence across all FGIDs was 60% to fructose, 51% to lactose and 33% to both. Malabsorption occurred in 45%, 32% and 16% respectively. There were no differences in intolerance or malabsorption prevalence between FGID subgroups. FGID symptoms correlated with symptoms evoked during testing (r = 0.35-0.61. P < 0.0001), but not with malabsorption. Non-GI symptoms occurred more commonly in patients with intolerances. Methane breath levels were not associated with constipation using several cut-off thresholds. Adequate symptom relief was achieved in >80% of intolerant patients, irrespective of malabsorption.
CONCLUSIONS
Fructose and lactose intolerances are common in FGID and associated with increased non-GI symptoms, but not with specific FGID subtypes. Symptoms experienced during breath testing, but not malabsorption, correlate with FGID symptoms. Effective symptom relief with dietary adaptation is not associated with malabsorption. Mechanisms relating to the generation of GI and non-GI symptoms due to lactose and fructose in FGID need to be explored further.