JLE

Hépato-Gastro & Oncologie Digestive

MENU

In patients with IBS symptoms, when should you evoke malabsorption? How to confirm it? Volume 27, issue 7, Septembre 2020

Figures


  • Figure 1

  • Figure 2

  • Figure 3

  • Figure 4

  • Figure 5

  • Figure 6

Tables

Authors
1 CHU de Rouen, Hôpital Charles Nicolle, Service d’hépato-gastroentérologie, 1 rue de Germont, 76031 Rouen Cedex
2 CHU de Rouen, Service de physiologie digestive, 1 rue de Germont, 76031 Rouen Cedex
3 INSERM UMR1073, 1 rue de Germont, 76031 Rouen Cedex
4 INSERM CIC-CRB 1404, Rouen, F-76031, France
* Correspondance

Irritable bowel syndrome (IBS) is a functional disorder defined by Rome IV criteria. The link between food and gastrointestinal symptoms has been recently highlighted. Among them, the deleterious role of some sugars: fructo-, oligo-, di-, monosaccharides and polyols (FODMAPs) is well known and low FODMAP diet is therefore recommended to treat IBS patients.

Bile acid malabsorption is present in one out to four IBS patients with diarrhoea. Bile acid chelator is an effective treatment. This malabsorption could be due to small intestinal bacterial overgrowth (SIBO). SIBO is found in 14 to 35% IBS patients and could be diagnosed with lactulose or glucose breath test. In case of SIBO, antibiotics could improve patient's health. Carbohydrate malabsorption is frequent in IBS patients. Indeed, FODMAP are poorly absorbed in the intestine and could lead to osmotic effect and to colonic fermentation by microbiota. FODMAP could lead to gastrointestinal symptoms. Lactose malabsorption is very common and in case of intolerance, a low lactose diet could be proposed (12g/d). Fructose malabsorption affected 1 out to 5 IBS patients. All these malabsorptions could be diagnosed by breath tests. Breath tests are simple, efficient and recommended to look for SIBO, constipation, bloating and carbohydrates maldigestion. These diagnoses should be looked after in refractory patients and in case of a strong link between symptoms and carbohydrates.