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Average daily intake of fructose varies from 11 to 54\u2003g around the world. Fructans are not hydrolysed or absorbed in the small intestine.<\/jats:p><jats:p>The physiological consequences of their malabsorption include increasing osmotic load, providing substrate for rapid bacterial fermentation, changing gastrointestinal motility, promoting mucosal biofilm and altering the profile of bacteria. These effects are additive with other short\u2010chain poorly absorbed carbohydrates such as sorbitol.<\/jats:p><jats:p>The clinical significance of these events depends upon the response of the bowel to such changes; they have a higher chance of inducing symptoms in patients with functional gut disorders than asymptomatic subjects. Restricting dietary intake of free fructose and\/or fructans may have durable symptomatic benefits in a high proportion of patients with functional gut disorders, but high quality evidence is lacking.<\/jats:p><jats:p>It is proposed that confusion over the clinical relevance of fructose malabsorption may be reduced by regarding it not as an abnormality but as a physiological process offering an opportunity to improve functional gastrointestinal symptoms by dietary change.<\/jats:p>","DOI":"10.1111\/j.1365-2036.2006.03186.x","type":"journal-article","created":{"date-parts":[[2010,7,23]],"date-time":"2010-07-23T11:53:49Z","timestamp":1279886029000},"page":"349-363","source":"Crossref","is-referenced-by-count":213,"title":["Review article: fructose malabsorption and the bigger picture"],"prefix":"10.1111","volume":"25","author":[{"given":"P. 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