TRENDS IN EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS FOR PATIENTS WITH ABDOMINAL PAIN AND HISTORY OF INFLAMMATORY BOWEL DISEASE

Introduction:Patients with chronic inflammatory bowel disease (IBD) might have a greater likelihood of also being fructose malabsorbers as compared to healthy controls.The aim of this study was to determine the prevalence and symptom severity of fructose malabsorption in patientswith active and inactive IBD compared to healthy controls.Materials and methods:The present study was a multi-center non-interventional diagnostic trial approved by the Ethics Committee of the Christian-Albrechts-University Kiel, Germany.Fifty-seven patients with active IBD, 93 patients with IBD in remission, and 101 healthy controls admitted to twelve different out-patient clinics for Internal Medicine in Germany were included prospectively.Fructose malabsorption was diagnosed by hydrogen breath testing after the ingestion of 50g fructose diluted in 300ml water and defined as an increase in H 2 levels by at least 20 parts per million compared to baseline.Patients diagnosed with bacterial over-population as diagnosed by the glucose breath test and non-H2 producers as diagnosed by the lactulose breath test that were tested negatively on fructose as well as lactose were excluded from the analyses.Gastrointestinal symptoms during the breath tests were evaluated using four-point items to determine subjective severity of bloating, abdominal pain and diarrhea.Results:251 participants were included in the study.205 patients (45 with active IBD, mean age 39.20 ± 13.48 years, 55.6% female; 80 with IBD in remission, mean age 43.03 ± 11.79 years, 58.8% female; 81 healthy controls, mean age 28.92 ± 8.81 years, 61.7 % female) remained after exclusion of bacterial overgrowth and non-H2 producer status.The number of patients diagnosed with fructose malabsorption -35/44 (79.6%) in patients with active IBD, 59/80 (73.8%) in patients with inactive IBD, and 66/81 (81.5%) in healthy controls -did not differ between the three groups (x 2 (2, N= 205) = 1.48, p= .48).Abdominal pain during testing was more frequent in patients with active IBD than in patients with IBD in remission (z = -2.936,p= .010)and diarrhea during testing was more frequent in patients with active IBD than in healthy controls (z = 2.489, p= .038).Discussion:Within the present study, fructose malabsorption is not more common in patients with IBD than in healthy subjects.However, the stronger symptoms in the patients with IBD may have pathological and therapeutic relevance.