M. Schmidtmann

Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption

Background/Aims Carbohydrate malabsorption is frequent in patients with functional gastrointestinal disorders and in healthy volunteers and can cause gastrointestinal symptoms mimicking irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of symptomatic lactose and fructose malabsorption in a large population of patients with IBS-like symptoms based on Rome II criteria. Methods Patients with unclear abdominal discomfort (n = 2,390) underwent lactose (50 g) and fructose (50 g) hydrogen (H2) breath tests and depending on the results further testing with 25 g fructose or 50 g glucose, or upper endoscopy with duodenal biopsies. Additionally, this population was investigated regarding the prevalence of small intestinal bacterial overgrowth (SIBO) based on glucose breath test and celiac disease. Results Of the 2,390 patients with IBS-like symptoms, 848 (35%) were symptomatic lactose malabsorbers and 1,531 (64%) symptomatic fructose malabsorbers. A combined symptomatic carbohydrate malabsorption was found in 587 (25%) patients. Severe fructose malabsorbers (pathologic 25 g fructose test) exhaled significantly higher H2 concentrations in the 50 g test than patients with negative 25 g fructose test (P < 0.001). Out of 460/659 patients with early significant H2 increase in the lactose and fructose test who underwent a glucose breath test, 88 patients had positive results indicative of SIBO and they were significantly older than patients with negative test result (P < 0.01). Celiac disease was found in 1/161 patients by upper endoscopy. Conclusions Carbohydrate malabsorption is a frequent but underestimated condition in patients with IBS-like symptoms although diagnosis can be easily confirmed by H2 breath testing.

Chronische Obstipation@@@Chronic constipation: Rationales Management bei Erwachsenen@@@Rational management in adults

ZusammenfassungDas Symptom der Obstipation zählt zu den häufigsten chronischen Beschwerden aller Altersgruppen weltweit. Die Ursachen reichen von genetisch determinierten oder erworbenen Störungen der Funktionen des Gastrointestinaltrakts oder Beckenbodens über die Auslösung durch Erkrankungen, bei denen die Obstipation ein Sekundärphänomen ist, bis hin zur Folge medizinischer Therapien oder persönlicher Lebens- und Verhaltensweisen. Die geringe Spezifität der Ursache bei großer Variabilität der Schwere mag dazu beitragen, dass – trotz der daraus oft resultierenden gravierenden Einschränkung der Lebensqualität – der Obstipation zumeist kein angemessener Krankheitswert zuerkannt wird. Zu dieser Tatsache tragen Tabuisierung, Frustration über den mäßigen Therapieerfolg und ökonomisch motivierte Grenzziehungen durch Kostenträger bei. Deshalb ist ein rationales, evidenzbasiertes Management der Diagnostik und Therapie beim „Volkssymptom“ Obstipation sehr wichtig. Die aktuell publizierte S2k-Leitlinie Chronische Obstipation, an der sich diese Übersicht orientiert, kann helfen, dieser Herausforderung gerecht werden zu können.AbstractConstipation is one of the most common chronic complaints in all age groups worldwide. Reasons are manifold, encompassing genetic or acquired functional disabilities of the gastrointestinal tract or pelvic floor, secondary phenomena due to other diseases, pharmacological side effects or personal way of life. The low causal specificity and high variability of symptom severity as well as misinformation, frustration about lacking therapeutic success and economically motivated factors may contribute to the circumstance that chronic constipation, although resulting in serious reduction of quality of life, is still not or rarely considered a disease of clinical significance. Therefore, a rational, evidence-based management of diagnostics and therapy of this widespread symptom is important. This review which is based on the recently published German S2k guidelines on chronic constipation will help to meet this challenge.