Fructose malabsorption associated with functional abdominal bloating: Case-control study

doi:10.4292/wjgpt.v17.i2.121264

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 121264
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.121264

Fructose malabsorption associated with functional abdominal bloating: Case-control study

Arivarasan Kulandaivelu, Venkatesh Vaithiyam, Kartik Mehta, Ravi Teja Reddy, Aarushi Ahuja, Nikhil Sirohi, Ujjwal Sonika, Ashok Dalal, Ajay Kumar, Amarender Singh Puri, Sanjeev Sachdeva

Arivarasan Kulandaivelu, Venkatesh Vaithiyam, Kartik Mehta, Ravi Teja Reddy, Aarushi Ahuja, Nikhil Sirohi, Ujjwal Sonika, Ashok Dalal, Ajay Kumar, Amarender Singh Puri, Sanjeev Sachdeva, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi 110002, Delhi, India

Co-first authors: Arivarasan Kulandaivelu and Venkatesh Vaithiyam.

Author contributions: Kulandaivelu A, Vaithiyam V, and Sachdeva S contributed to conceptualisation, writing, reviewing, and editing; Mehta K, Vaithiyam V wrote the original draft; Puri AS, Vaithiyam V, Sirohi N, and Reddy RT participated in acquisition of data and drafting the manuscript; Sonika U, Dalal A, Kumar A, Ahuja A, and Mehta K participated in interpretation of data and critical revision of the data; Vaithiyam V and Sachdeva S did the final review of the manuscript, and all authors have read and approved the final version of the manuscript.

Institutional review board statement: The Institutional Ethics Committee of Maulana Azad Medical College and associated hospitals granted ethical approval (F. No. 11/IEC/MAMC/2011/206) and approved this study, which was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki.

Informed consent statement: All participants provided written informed consent before enrolment.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: All data related to the study are available from the corresponding author in the Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, and will be provided upon reasonable request.

Corresponding author: Sanjeev Sachdeva, Director, Head, Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, JL Nehru Marg, New Delhi 110002, Delhi, India. sanjeevgastro@rediffmail.com

Received: March 22, 2026
Revised: April 24, 2026
Accepted: May 11, 2026
Published online: June 5, 2026
Processing time: 68 Days and 22.2 Hours

Abstract

BACKGROUND

Abdominal bloating is a common symptom in patients with functional gastrointestinal disorders (FGIDs). The pathophysiology of bloating remains poorly understood. Fructose malabsorption (FM) has been implicated in the pathogenesis of various FGIDs. However, there is limited data on the role of FM in patients with functional abdominal bloating.

AIM

To investigate the prevalence and predictors of FM in patients with functional bloating.

METHODS

This case-control study included 70 patients with functional bloating who met the Rome III criteria and 35 healthy controls. All participants were initially tested for small intestinal bacterial overgrowth, and those who tested negative subsequently underwent a fructose hydrogen breath test (FHBT) to evaluate FM. Breath hydrogen and methane levels were measured at baseline and every 15 minutes for 3 hours. A rise in breath hydrogen or methane levels > 20 ppm above baseline was considered positive. Symptoms were recorded during the test.

RESULTS

FM was detected in 20/70 (29%) patients with functional bloating, compared with 1/35 (3%) in healthy controls (P = 0.01). 51/105 (48%) participants had symptoms during the test, and subjects with positive FHBT had a significantly higher prevalence of symptoms than those with negative FHBT (76% vs 42%; P < 0.01). A subset of patients with functional bloating who tested negative for FHBT had symptoms during FHBT, suggesting a mechanism beyond FM, such as visceral hypersensitivity, in the pathogenesis of functional bloating (80% vs 62%; P = 0.14). Female sex was an independent predictor of FM in the multivariate analysis (P = 0.02). Methane producers were present in 32/70 (46%) patients.

CONCLUSION

More than one-fourth of patients with functional bloating had FM. Future multicentre prospective studies should evaluate the role of fructose-restricted diets in managing functional bloating.

Keywords: Fructose malabsorption; Fructose intolerance; Functional bloating; Small intestinal bacterial overgrowth; Methane producer

Core Tip: Fructose malabsorption (FM) is increasingly recognised as a contributor to functional gastrointestinal symptoms. In this case-control study, FM was significantly more common in patients with functional abdominal bloating than in healthy controls (29% vs 3%). A subset of patients with functional bloating who tested negative for the fructose hydrogen breath test (FHBT) had symptoms during the FHBT, suggesting a mechanism beyond fructose malabsorption, such as visceral hypersensitivity, in the pathogenesis of functional bloating. Female sex was identified as an independent predictor. These findings suggest that FM may be an important, potentially modifiable factor in patients presenting with functional bloating.