Recurrent Abdominal Pain Caused by Sorbitol Malabsorption

Sorbitol is a carbohydrate, a monosaccharide polyalcohol, naturally present in fruits and juices. It is also widely used as a “sugar-free” substitute sweetener in the food industry, especially in sweets, chewing gum and diet products [1,2]. The incidence of sorbitol intolerance in the general population is estimated at 8 to 12% and are frequently combined with adverse food reactions, food allergies, and irritable bowel syndrome (IBS). Sorbitol undergoes only slight intestinal resorption by passive diffusion and absorption is dose and concentration related. Sorbitol can be transformed into fructose within the intestine, blocking GLUT-5 transporter, so the symptoms are the same as those of fructose malabsorption [2,3]. This results in the typical cardinal symptoms of postprandial flatulence, nausea, meteorism, diarrhea, and nonspecific abdominal pain [4]. Sorbitol H2 breath test is effective in detecting small bowel damage with a relevant reduction of absorption surface. In carbohydrate malabsorption false positive tests for small intestinal bacterial overgrowth may occur due to colonic fermentation and production of gas. In gastrointestinal motor disorders, delayed gastric emptying may cause false negative tests, and rapid transit through small bowel may result in false positive breath tests, false positive results may also occur if the subject does not adhere to a low fiber diet the day before the test [5].