Apple juice. An unappreciated cause of chronic diarrhea
J. S. Hyams and A. M. Leichtner
Chronic nonspecific diarrhea (CNSD) remains a common pediatric problem.
Previous reports have suggested disordered small intestinal motility, food
intolerances, dietary fat restriction, and excessive fluid consumption as
possible contributory factors. We have recently encountered a subset of
children with CNSD in whom nonexcessive apple juice intake seemed to cause
their diarrhea. In five subjects, ingestion of 240 mL of apple juice
disclosed evidence of significant carbohydrate malabsorption by
breath-hydrogen testing and resulted in diarrhea. Withdrawal of apple juice
from the diets of these subjects was curative in all cases. Before
embarking on an expensive and time-consuming evaluation for CNSD in
otherwise healthy children, a brief restriction of apple juice intake may
be warranted.
