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Mistakes in the management of carbohydrate intolerance and how to avoid them

Johann Hammer, Heinz Florian Hammer, Mark Fox

Summary

AI Generated

Carbohydrates not absorbed in the small intestine are fermented by colonic bacteria to organic acids and gases, and carbohydrate malabsorption can be diagnosed using the hydrogen breath test.

  • Colonic bacteria ferment unabsorbed carbohydrates to produce organic acids and gases including carbon dioxide, hydrogen, and methane.
  • Part of the produced acids and gases is absorbed in the colon while part remains in the lumen.
  • Large interindividual differences have been demonstrated for the production of acids and gas.
  • The hydrogen breath test can diagnose carbohydrate malabsorption because gases produced after a provocative carbohydrate dose are unique products of bacterial fermentation.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Saunders DR and Wiggins HS. Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol 1981; 241: G397-402. [Link]
2.
Miller TL and Wolin MJ. Fermentations by saccharolytic intestinal bacteria. Am J Clin Nutr 1979; 32: 164-72. [Link]
3.
Hammer HF and Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am 2012; 41: 611-27. [Link]
4.
Hammer H, Fine K, Santa Ana C, et al. Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. J Clin Invest 1990; 86: 1936-44. [Link]
5.
Hammer HF and Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption - effect of simethicone. European Journal of Gastroenterology and Hepatology 1992; 4: 141-5.
6.
Wilder-Smith CH, Materna A, Wermelinger C, et al. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther 2013; 37: 1074-83. [Link]
7.
Hammer HF, Petritsch W, Pristautz H, et al. Evaluation of the pathogenesis of flatulence and abdominal cramps in patients with lactose malabsorption. Wien Klin Wochenschr 1996; 108: 175-9. [Link]
8.
Mikhael-Moussa H, Desprez C, Gillibert A, et al. Is carbohydrate intolerance associated with carbohydrate malabsorption in disorders of gut-brain interaction? Am J Gastroenterol. Epub ahead of print 8 Apr 2025. DOI: 10.14309/ajg.0000000000003483. [Link]
9.
Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10: 15-40. [Link]
10.
Hammer J, Sonyi M, Engesser KM, et al. Carbohydrate-induced gastrointestinal symptoms: development and validation of a test-specific symptom questionnaire for an adult population, the adult Carbohydrate Perception Questionnaire. Eur J Gastroenterol Hepatol 2021; 32: 171-7. [Link]
11.
Hammer J, Memaran N, Huber WD, et al. Development and validation of the paediatric Carbohydrate Perception Questionnaire (pCPQ), an instrument for the assessment of carbohydrate-induced gastrointestinal symptoms in the paediatric population. Neurogastroenterol Motil 2020; 32: e13934. [Link]
12.
Sonyi M, Hammer J, Basilisco G, et al. Coordinated Multi-Language Translation of A Validated Symptom Questionnaire for Carbohydrate Intolerances: A Practical Structured Procedure. J Gastrointestin Liver Dis 2022; 31: 331-5. [Link]
13.
Klare C, Hammer J and Hammer HF. The adult carbohydrate perception questionnaire identifies patients with lactose or fructose intolerance who respond to diet. Digestive Diseases 2024; 42: 276-84. [Link]
14.
Schindler V, Giezendanner S, Van Oudenhove L, et al. Better response to low FODMAP diet in disorders of gut-brain interaction patients with pronounced hydrogen response to a nutrient challenge test. J Gastroenterol Hepatol 2021; 36: 3322-8. [Link]
15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
Turnbull JL, Adams HN and Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41: 3-25. [Link]
21.
DeGeeter C and Guandalini S. Food Sensitivities: Fact Versus Fiction. Gastroenterol Clin North Am 2018; 47: 895-908. [Link]
22.
Leis R, de Castro MJ, de Lamas C, et al. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients 2020; 12: 1487. [Link]
23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84: 1056-62. [Link]
26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
Bohn L, Storsrud S, Tornblom H, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634-41. [Link]
33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

Carbohydrates not absorbed in the small intestine are fermented by colonic bacteria to organic acids and gases(e.g. carbon dioxide, hydrogen and methane), part of which is absorbed in the colon, the other part remaining in the lumen. Large interindividual differences have been demonstrated for the production of such acids and gas. Carbohydrate malabsorption can be diagnosed by using the hydrogen breath test, because the gases produced after administration of a provocative dose of carbohydrate are unique products of bacterial carbohydrate fermentation.

Topics

Small Intestine & Nutrition

Citation

Hammer HF, Hammer J and Fox M. Mistakes in the management of carbohydrate intolerance and how to avoid them. UEG Education 2019; 19: 9–14

Published

2019

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UEG Mistakes In Articles
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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Saunders DR and Wiggins HS. Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol 1981; 241: G397-402. [Link]
2.
Miller TL and Wolin MJ. Fermentations by saccharolytic intestinal bacteria. Am J Clin Nutr 1979; 32: 164-72. [Link]
3.
Hammer HF and Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am 2012; 41: 611-27. [Link]
4.
Hammer H, Fine K, Santa Ana C, et al. Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. J Clin Invest 1990; 86: 1936-44. [Link]
5.
Hammer HF and Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption - effect of simethicone. European Journal of Gastroenterology and Hepatology 1992; 4: 141-5.
6.
Wilder-Smith CH, Materna A, Wermelinger C, et al. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther 2013; 37: 1074-83. [Link]
7.
Hammer HF, Petritsch W, Pristautz H, et al. Evaluation of the pathogenesis of flatulence and abdominal cramps in patients with lactose malabsorption. Wien Klin Wochenschr 1996; 108: 175-9. [Link]
8.
Mikhael-Moussa H, Desprez C, Gillibert A, et al. Is carbohydrate intolerance associated with carbohydrate malabsorption in disorders of gut-brain interaction? Am J Gastroenterol. Epub ahead of print 8 Apr 2025. DOI: 10.14309/ajg.0000000000003483. [Link]
9.
Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10: 15-40. [Link]
10.
Hammer J, Sonyi M, Engesser KM, et al. Carbohydrate-induced gastrointestinal symptoms: development and validation of a test-specific symptom questionnaire for an adult population, the adult Carbohydrate Perception Questionnaire. Eur J Gastroenterol Hepatol 2021; 32: 171-7. [Link]
11.
Hammer J, Memaran N, Huber WD, et al. Development and validation of the paediatric Carbohydrate Perception Questionnaire (pCPQ), an instrument for the assessment of carbohydrate-induced gastrointestinal symptoms in the paediatric population. Neurogastroenterol Motil 2020; 32: e13934. [Link]
12.
Sonyi M, Hammer J, Basilisco G, et al. Coordinated Multi-Language Translation of A Validated Symptom Questionnaire for Carbohydrate Intolerances: A Practical Structured Procedure. J Gastrointestin Liver Dis 2022; 31: 331-5. [Link]
13.
Klare C, Hammer J and Hammer HF. The adult carbohydrate perception questionnaire identifies patients with lactose or fructose intolerance who respond to diet. Digestive Diseases 2024; 42: 276-84. [Link]
14.
Schindler V, Giezendanner S, Van Oudenhove L, et al. Better response to low FODMAP diet in disorders of gut-brain interaction patients with pronounced hydrogen response to a nutrient challenge test. J Gastroenterol Hepatol 2021; 36: 3322-8. [Link]
15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
Turnbull JL, Adams HN and Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41: 3-25. [Link]
21.
DeGeeter C and Guandalini S. Food Sensitivities: Fact Versus Fiction. Gastroenterol Clin North Am 2018; 47: 895-908. [Link]
22.
Leis R, de Castro MJ, de Lamas C, et al. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients 2020; 12: 1487. [Link]
23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84: 1056-62. [Link]
26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
Bohn L, Storsrud S, Tornblom H, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634-41. [Link]
33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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UEG Mistakes In Articles
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Mistakes in rumination syndrome and how to avoid them

Alberto Ezquerra-Durán, Elizabeth Barba Orozco

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
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6.
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7.
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8.
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10.
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11.
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12.
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13.
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14.
Schindler V, Giezendanner S, Van Oudenhove L, et al. Better response to low FODMAP diet in disorders of gut-brain interaction patients with pronounced hydrogen response to a nutrient challenge test. J Gastroenterol Hepatol 2021; 36: 3322-8. [Link]
15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
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21.
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22.
Leis R, de Castro MJ, de Lamas C, et al. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients 2020; 12: 1487. [Link]
23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84: 1056-62. [Link]
26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
Bohn L, Storsrud S, Tornblom H, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634-41. [Link]
33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

Topics

Neurogastroenterology & Motility

Citation

Ezquerra-Durán A and Barba-Orozco E. Mistakes in rumination syndrome and how to avoid them. UEG Education 2025; 25: 10-13.

Published

2025

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in gastroparesis and how to avoid them

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Saunders DR and Wiggins HS. Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol 1981; 241: G397-402. [Link]
2.
Miller TL and Wolin MJ. Fermentations by saccharolytic intestinal bacteria. Am J Clin Nutr 1979; 32: 164-72. [Link]
3.
Hammer HF and Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am 2012; 41: 611-27. [Link]
4.
Hammer H, Fine K, Santa Ana C, et al. Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. J Clin Invest 1990; 86: 1936-44. [Link]
5.
Hammer HF and Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption - effect of simethicone. European Journal of Gastroenterology and Hepatology 1992; 4: 141-5.
6.
Wilder-Smith CH, Materna A, Wermelinger C, et al. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther 2013; 37: 1074-83. [Link]
7.
Hammer HF, Petritsch W, Pristautz H, et al. Evaluation of the pathogenesis of flatulence and abdominal cramps in patients with lactose malabsorption. Wien Klin Wochenschr 1996; 108: 175-9. [Link]
8.
Mikhael-Moussa H, Desprez C, Gillibert A, et al. Is carbohydrate intolerance associated with carbohydrate malabsorption in disorders of gut-brain interaction? Am J Gastroenterol. Epub ahead of print 8 Apr 2025. DOI: 10.14309/ajg.0000000000003483. [Link]
9.
Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10: 15-40. [Link]
10.
Hammer J, Sonyi M, Engesser KM, et al. Carbohydrate-induced gastrointestinal symptoms: development and validation of a test-specific symptom questionnaire for an adult population, the adult Carbohydrate Perception Questionnaire. Eur J Gastroenterol Hepatol 2021; 32: 171-7. [Link]
11.
Hammer J, Memaran N, Huber WD, et al. Development and validation of the paediatric Carbohydrate Perception Questionnaire (pCPQ), an instrument for the assessment of carbohydrate-induced gastrointestinal symptoms in the paediatric population. Neurogastroenterol Motil 2020; 32: e13934. [Link]
12.
Sonyi M, Hammer J, Basilisco G, et al. Coordinated Multi-Language Translation of A Validated Symptom Questionnaire for Carbohydrate Intolerances: A Practical Structured Procedure. J Gastrointestin Liver Dis 2022; 31: 331-5. [Link]
13.
Klare C, Hammer J and Hammer HF. The adult carbohydrate perception questionnaire identifies patients with lactose or fructose intolerance who respond to diet. Digestive Diseases 2024; 42: 276-84. [Link]
14.
Schindler V, Giezendanner S, Van Oudenhove L, et al. Better response to low FODMAP diet in disorders of gut-brain interaction patients with pronounced hydrogen response to a nutrient challenge test. J Gastroenterol Hepatol 2021; 36: 3322-8. [Link]
15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
Turnbull JL, Adams HN and Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41: 3-25. [Link]
21.
DeGeeter C and Guandalini S. Food Sensitivities: Fact Versus Fiction. Gastroenterol Clin North Am 2018; 47: 895-908. [Link]
22.
Leis R, de Castro MJ, de Lamas C, et al. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients 2020; 12: 1487. [Link]
23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84: 1056-62. [Link]
26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
Bohn L, Storsrud S, Tornblom H, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634-41. [Link]
33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

The term ‘gastroparesis’ was first coined by Kassander in 1958 to describe the fact that barium did not leave the stomach of patients with diabetes for over 24 hours — so-called ‘gastroparesis diabeticorum’. Nowadays it refers to a delay in gastric emptying that is associated with symptoms primarily of nausea and vomiting as well as the absence of mechanical obstruction. In 1958, 21 cases were described, but in 2019, 5 million US individuals were diagnosed as having gastroparesis. This rapid increase in prevalence is likely to have occurred because it has become much easier to measure gastric emptying and to attribute symptoms to this without necessarily thinking through differentials. The incidence of hospital admissions for patients labelled as having gastroparesis is rapidly rising, increasing at a much faster rate than admissions for patients with nausea and vomiting, gastro-oesophageal reflux disease, gastritis or gastric ulcers, which are all remaining relatively static. Gastroparesis therefore represents a major healthcare burden. Gastroparesis can be idiopathic or is most frequently caused by diabetes (type 1 more than type 2) or surgical procedures that can disrupt the vagus nerve (e.g. Billroth gastrectomy, oesophagectomy, gastric bypass surgery and fundoplication). In this article, I describe the mistakes most frequently made in patients who have a suspected diagnosis of gastroparesis. I base my discussion on the available evidence as well as clinical experience in the field. 


Topics

Neurogastroenterology & Motility Stomach & H. Pylori

Citation

Fikree A. Mistakes in gastroparesis and how to avoid them. UEG Education 2021; 21: 18–22.

Published

2021

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Saunders DR and Wiggins HS. Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol 1981; 241: G397-402. [Link]
2.
Miller TL and Wolin MJ. Fermentations by saccharolytic intestinal bacteria. Am J Clin Nutr 1979; 32: 164-72. [Link]
3.
Hammer HF and Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin North Am 2012; 41: 611-27. [Link]
4.
Hammer H, Fine K, Santa Ana C, et al. Carbohydrate malabsorption. Its measurement and its contribution to diarrhea. J Clin Invest 1990; 86: 1936-44. [Link]
5.
Hammer HF and Sheikh MS. Colonic gas excretion in induced carbohydrate malabsorption - effect of simethicone. European Journal of Gastroenterology and Hepatology 1992; 4: 141-5.
6.
Wilder-Smith CH, Materna A, Wermelinger C, et al. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther 2013; 37: 1074-83. [Link]
7.
Hammer HF, Petritsch W, Pristautz H, et al. Evaluation of the pathogenesis of flatulence and abdominal cramps in patients with lactose malabsorption. Wien Klin Wochenschr 1996; 108: 175-9. [Link]
8.
Mikhael-Moussa H, Desprez C, Gillibert A, et al. Is carbohydrate intolerance associated with carbohydrate malabsorption in disorders of gut-brain interaction? Am J Gastroenterol. Epub ahead of print 8 Apr 2025. DOI: 10.14309/ajg.0000000000003483. [Link]
9.
Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J 2022; 10: 15-40. [Link]
10.
Hammer J, Sonyi M, Engesser KM, et al. Carbohydrate-induced gastrointestinal symptoms: development and validation of a test-specific symptom questionnaire for an adult population, the adult Carbohydrate Perception Questionnaire. Eur J Gastroenterol Hepatol 2021; 32: 171-7. [Link]
11.
Hammer J, Memaran N, Huber WD, et al. Development and validation of the paediatric Carbohydrate Perception Questionnaire (pCPQ), an instrument for the assessment of carbohydrate-induced gastrointestinal symptoms in the paediatric population. Neurogastroenterol Motil 2020; 32: e13934. [Link]
12.
Sonyi M, Hammer J, Basilisco G, et al. Coordinated Multi-Language Translation of A Validated Symptom Questionnaire for Carbohydrate Intolerances: A Practical Structured Procedure. J Gastrointestin Liver Dis 2022; 31: 331-5. [Link]
13.
Klare C, Hammer J and Hammer HF. The adult carbohydrate perception questionnaire identifies patients with lactose or fructose intolerance who respond to diet. Digestive Diseases 2024; 42: 276-84. [Link]
14.
Schindler V, Giezendanner S, Van Oudenhove L, et al. Better response to low FODMAP diet in disorders of gut-brain interaction patients with pronounced hydrogen response to a nutrient challenge test. J Gastroenterol Hepatol 2021; 36: 3322-8. [Link]
15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
Turnbull JL, Adams HN and Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41: 3-25. [Link]
21.
DeGeeter C and Guandalini S. Food Sensitivities: Fact Versus Fiction. Gastroenterol Clin North Am 2018; 47: 895-908. [Link]
22.
Leis R, de Castro MJ, de Lamas C, et al. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients 2020; 12: 1487. [Link]
23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
Hammer HF, Santa Ana CA, Schiller LR, et al. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 1989; 84: 1056-62. [Link]
26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
Bohn L, Storsrud S, Tornblom H, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634-41. [Link]
33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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UEG Mistakes In Articles
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Mistakes in transitional care for children and young adults and how to avoid them

Patrizia Burra, Hans Törnblom, Jorge Amil Dias, Moriam Mustapha

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
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8.
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11.
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12.
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13.
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14.
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15.
Zhang Y, Feng L, Wang X, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. Am J Clin Nutr 2021; 113: 1531-45. [Link]
16.
Levitt M, Wilt T and Shaukat A. Clinical implications of lactose malabsorption versus lactose intolerance. J Clin Gastroenterol 2013; 47: 471-80. [Link]
17.
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18.
Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective. United European Gastroenterol J 2025; 13: 773-97. [Link]
19.
Melchior C, Hammer H, Bor S, et al. European consensus on functional bloating and abdominal distension – an ESNM/UEG recommendations for clinical management. United European Gastroenterol J. Epub ahead of print 22 Aug 2025. DOI: 10.1002/ueg2.70098 [Link]
20.
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21.
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22.
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23.
Francesconi CF, Machado MB, Steinwurz F, et al. Oral Administration of Exogenous Lactase in Tablets for Patients Diagnosed with Lactose Intolerance Due to Primary Hypolactasia. Arq Gastroenterol 2016; 53: 228-34. [Link]
24.
Komericki P, Akkilic-Materna M, Strimitzer T, et al. Oral xylose isomerase decreases breath hydrogen excretion and improves gastrointestinal symptoms in fructose malabsorption - a double-blind, placebo-controlled study. Aliment Pharmacol Ther 2012; 36: 980-7. [Link]
25.
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26.
Major G, Pritchard S, Murray K, et al. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Gastroenterology 2017; 152: 124-33 e2. [Link]
27.
Melgaard D, Sorensen J, Riis J, et al. Efficacy of FODMAP Elimination and Subsequent Blinded Placebo-Controlled Provocations in a Randomised Controlled Study in Patients with Ulcerative Colitis in Remission and Symptoms of Irritable Bowel Syndrome: A Feasibility Study. Nutrients 2022; 14: 1296. [Link]
28.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
29.
Zhao J, Fox M, Cong Y, et al. Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2010; 31: 892-900. [Link]
30.
Yang J, Fox M, Cong Y, et al. Lactose intolerance in irritable bowel syndrome patients with diarrhoea: the roles of anxiety, activation of the innate mucosal immune system and visceral sensitivity. Aliment Pharmacol Ther 2014; 39: 302-11. [Link]
31.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25: 260-74. [Link]
32.
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33.
Zheng X, Chu H, Cong Y, et al. Self-reported lactose intolerance in clinic patients with functional gastrointestinal symptoms: prevalence, risk factors, and impact on food choices. Neurogastroenterol Motil 2015; 27: 1138-46. [Link]
34.
Yang J, Deng Y, Chu H, et al. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2013; 11: 262-8 e1. [Link]
35.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
36.
Black CJ, Staudacher HM and Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut 2022; 71: 1117-26. [Link]
37.
Colomier E, Van Oudenhove L, Tack J, et al. Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome. Nutrients 2022; 14: 397. [Link]
38.
Misselwitz B, Butter M, Verbeke K, et al. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut 2019; 68: 2080-91. [Link]
39.
Stephen A and Phillips S. Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology 1983; 85: 589-95. [Link]
40.
Flourie B, Florent C, Jouany J, et al. Colonic metabolism of wheat starch in healthy humans: effects on fecal outputs and clinical symptoms. Gastroenterology 1986; 90: 111-9. [Link]
41.
Cummings JH and Macfarlane GT. The control and consequences of bacterial fermentation in the human colon. J Appl Bacteriol 1991; 70: 443-59. [Link]
42.
Flourie B, Leblond A, Florent C, et al. Starch malabsorption and breath gas excretion in healthy humans consuming low- and high-starch diets. Gastroenterology 1988; 95: 356-63. [Link]
43.
Peng AW, Juraschek SP, Appel LJ, et al. Effects of the DASH Diet and Sodium Intake on Bloating: Results From the DASH-Sodium Trial. Am J Gastroenterol 2019; 114: 1109-15. [Link]
44.
Zhang M, Juraschek SP, Appel LJ, et al. Effects of High-Fiber Diets and Macronutrient Substitution on Bloating: Findings From the OmniHeart Trial. Clin Transl Gastroenterol 2020; 11: e00122. [Link]
45.
Shepherd S, Parker F, Muir J, et al. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6: 765-71. [Link]
46.
Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-8 e1-3. [Link]
47.
Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology 2018; 154: 529-39 e2. [Link]
48.
Eswaran S, Jencks KJ, Singh P, et al. All FODMAPs Aren't Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2025; 23: 351-8 e5. [Link]
49.
Schneider E, Sabate JM, Bouchoucha M, et al. FODMAP Consumption by Adults from the French Population-Based NutriNet-Sante Cohort. J Nutr 2021; 151: 3180-6. [Link]
50.
Molina-Infante J, Serra J, Fernandez-Banares F, et al. The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol 2016; 39: 55-65. [Link]
51.
Alrasheedi AA, Jahlan EA and Bakarman MA. The effect of low-FODMAP diet on patients with irritable bowel syndrome. Sci Rep 2025; 15: 16382. [Link]
52.
Harvie RM, Chisholm AW, Bisanz JE, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol 2017; 23: 4632-43. [Link]
53.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients 2020; 12: 148. [Link]
54.
Huaman JW, Mego M, Manichanh C, et al. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155: 1004-7. [Link]
55.
Mitchell H, Porter J, Gibson P, et al. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49: 124-39. [Link]
56.
Singh P, Chey SW, Nee J, et al. Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial. Clin Gastroenterol Hepatol 2025; 23: 362-4 e2. [Link]
57.
Murray K, Wilkinson-Smith V, Hoad C, et al. Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI. Am J Gastroenterol 2014; 109: 110-9. [Link]
58.
Hogenauer C, Hammer HF, Mellitzer K, et al. Evaluation of a new DNA test compared with the lactose hydrogen breath test for the diagnosis of lactase non-persistence. Eur J Gastroenterol Hepatol 2005; 17: 371-6. [Link]
59.
Levitt MD and Donaldson RM. Use of respiratory hydrogen (H2) excretion to detect carbohydrate malabsorption. J Lab Clin Med 1970; 75: 937-45. [Link]
60.
Lenti M, Hammer H, Tacheci I, et al. European consensus on Malabsorption – UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, clinical phenotypes,and diagnostic testing for malabsorption. United European Gastroenterol J 2025; 13: 599-613. [Link]
61.
Hammer J and Hammer H. Carboception: Selbstdiagose und Therapieanpassung bei Kohlenhydratintoleranzen mittels CE-zertifizierter App. Z Gastroenterol 2025; 65: e321-e2. [Link]
62.
Vernia P, Di Camillo M, Foglietta T, et al. Diagnosis of lactose intolerance and the 'nocebo' effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616-9. [Link]
63.
Levitt M, Wilt T and A. S. Clinical implications of lactose malabsorption versus lactose intolerance. Am J Clin Gastroenterol 2013; 47: 471-80. [Link]
64.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; 192: 1-410. [Link]
65.
Lerebours E, N'Djitoyap Ndam C, Lavoine A, et al. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Am J Clin Nutr 1989; 49: 823-7. [Link]
66.
Staudacher HM, Whelan K, Irving PM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24: 487-95. [Link]
67.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75 e5. [Link]
68.
Suarez FL, Savaiano DA and Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 1995; 333: 1-4. [Link]
69.
Simren M, Abrahamsson H and Bjornsson ES. Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors. Clin Gastroenterol Hepatol 2007; 5: 201-8. [Link]
70.
Fox M, Barr C, Nolan S, et al. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol 2007; 5: 439-44. [Link]
71.
Mooradian AD, Smith M and Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A narrative review. Clin Nutr ESPEN 2017; 18: 1-8. [Link]
72.
Obermayer-Pietsch BM, Gugatschka M, Reitter S, et al. Adult-type hypolactasia and calcium availability: decreased calcium intake or impaired calcium absorption? Osteoporos Int 2007; 18: 445-51. [Link]

Abstract

Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

2023

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

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Mistakes in the management of unexplained diarrhoea and how to avoid them

Magnus Simrén, Hans Törnblom

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References

Mistakes
References
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Abstract

Diarrhoea, acute or chronic, is a common gastrointestinal symptom in healthcare. In most cases, acute diarrhoea in healthy individuals requires limited diagnostic and therapeutic efforts, except for the replacement of fluid electrolytes, and stool culture in severe occurrences. Acute diarrhoea is often self-limiting due to short-lived reactions to food intake and bacterial or viral infections. However, diarrhoea can persist and fulfil definitions of chronicity when a month or more has passed since the onset. Here we discuss some basic mistakes that should be avoided when managing unexplained non-bloody diarrhoea that persists beyond the acute setting. In this context, the term 'unexplained' refers to a patient without apparent alarm features and where initial consultations have failed at making a diagnosis. We used an evidence-based approach and included aspects predominantly based on clinical experience when appropriate.


Topics

Neurogastroenterology & Motility

Citation

Törnblom H and Simrén M. Mistakes in the management of unexplained diarrhoea and how to avoid them. UEG Education 2022; 22: 16–19.

Published

2022

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Mistakes in the management of unexplained diarrhoea and how to avoid them

Mistakes in the management of unexplained diarrhoea and how to avoid them

Magnus Simrén Magnus Simrén, Hans Törnblom

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