Clear fluids high in fructose (e.g., apple juice) have been incriminated for symptoms of chronic non-specific diarrhoea (CNSD), in particular in children 1-4 years of age. H2 breath tests were performed, after ingestion of fructose (1 g/kg), in 15 patients referred with CNSD and 35 controls. All 15 CNSD children (100%) had breath peak H2 of > or = 20 ppm versus 49% of the 35 controls (P = 0.0005). Median peak H2 in CNSD (90 ppm, range 31-136) was significantly higher than in controls (20 ppm, range 1-139) (P < 0.001). Orocoecal transit time in children with positive tests was similar in both groups. Similarly, median H2 increases during the test period had the same distribution. We demonstrated fructose malabsorption in CNSD, but found a great overlap with the control group. Our results strongly discourage the use of fructose breath H2 tests in children suspected of CNSD. A positive test has no diagnostic value and a negative test has no clinical implications.
Conclusion: For clinical practice, we suggest a dietary history and a trial of appropriate measures in infants with chronic nonspecific diarrhoea, instead of performing the fructose H2 breath test.