Skip to main content
NCBI home page
Gut logoLink to Gut
. 1990 Nov;31(11):1324–1328. doi: 10.1136/gut.31.11.1324

Monitoring enzyme replacement treatment in exocrine pancreatic insufficiency using the cholesteryl octanoate breath test.

S Mundlos 1, P Kühnelt 1, G Adler 1
PMCID: PMC1378708  PMID: 2253920

Abstract

The cholesteryl-14C-octanoate breath test was used to monitor the intraluminal enzymatic activity of pancreatin preparations in six patients with severe pancreatic insufficiency. Conventional enzyme replacement, with cimetidine as an adjunct, was compared to supplementation with enteric coated microspheres. In healthy control subjects, 14CO2 excretion rose rapidly and peaked at 90-120 minutes; mean (SD) cumulative recovery at four hours was 51 (8)%. In patients with pancreatic insufficiency on no treatment mean (SD) cumulative recovery was only 6 (4)%. After pancreatin, with previous administration of cimetidine, it increased to 27 (11)% with a time course resembling that in controls. With 2 mm enteric coated microspheres, 14CO2 excretion did not rise significantly before 120 minutes and cumulative recovery after four hours was 15 (11)%. In a control study, 2 mm radio-opaque microspheres did not empty from the stomach until two hours after ingestion. The results suggest that the cholesteryl octanoate breath test can be successfully used to monitor the intraluminal enzymatic activity after treatment with different forms of enzyme replacement in pancreatic insufficiency. In contrast to treatment with conventional pancreatin and cimetidine as an adjunct, 2 mm enteric coated microspheres did not show in vivo enzymatic activity until two hours after administration.

Full text

PDF
1324

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cole S. G., Rossi S., Stern A., Hofmann A. F. Cholesteryl octanoate breath test. Preliminary studies on a new noninvasive test of human pancreatic exocrine function. Gastroenterology. 1987 Dec;93(6):1372–1380. [PubMed] [Google Scholar]
  2. DiMagno E. P., Malagelada J. R., Go V. L., Moertel C. G. Fate of orally ingested enzymes in pancreatic insufficiency. Comparison of two dosage schedules. N Engl J Med. 1977 Jun 9;296(23):1318–1322. doi: 10.1056/NEJM197706092962304. [DOI] [PubMed] [Google Scholar]
  3. Dutta S. K., Hubbard V. S., Appler M. Critical examination of therapeutic efficacy of a pH-sensitive enteric-coated pancreatic enzyme preparation in treatment of exocrine pancreatic insufficiency secondary to cystic fibrosis. Dig Dis Sci. 1988 Oct;33(10):1237–1244. doi: 10.1007/BF01536673. [DOI] [PubMed] [Google Scholar]
  4. Dutta S. K., Rubin J., Harvey J. Comparative evaluation of the therapeutic efficacy of a pH-sensitive enteric coated pancreatic enzyme preparation with conventional pancreatic enzyme therapy in the treatment of exocrine pancreatic insufficiency. Gastroenterology. 1983 Mar;84(3):476–482. [PubMed] [Google Scholar]
  5. Gallo L. L., Chiang Y., Vahouny G. V., Treadwell C. R. Localization and origin at rat intestinal cholesterol esterase determined by immunocytochemistry. J Lipid Res. 1980 Jul;21(5):537–545. [PubMed] [Google Scholar]
  6. Graham D. Y. An enteric-coated pancreatic enzyme preparation that works. Dig Dis Sci. 1979 Dec;24(12):906–909. doi: 10.1007/BF01311943. [DOI] [PubMed] [Google Scholar]
  7. Greenberger N. J., Skillman T. G. Medium-chain triglycerides. N Engl J Med. 1969 May 8;280(19):1045–1058. doi: 10.1056/NEJM196905082801906. [DOI] [PubMed] [Google Scholar]
  8. Lankisch P. G., Lembcke B., Göke B., Creutzfeldt W. Therapy of pancreatogenic steatorrhoea: does acid protection of pancreatic enzymes offer any advantage? Z Gastroenterol. 1986 Dec;24(12):753–757. [PubMed] [Google Scholar]
  9. Marotta F., O'Keefe S. J., Marks I. N., Girdwood A., Young G. Pancreatic enzyme replacement therapy. Importance of gastric acid secretion, H2-antagonists, and enteric coating. Dig Dis Sci. 1989 Mar;34(3):456–461. doi: 10.1007/BF01536271. [DOI] [PubMed] [Google Scholar]
  10. Meyer J. H., Elashoff J., Porter-Fink V., Dressman J., Amidon G. L. Human postprandial gastric emptying of 1-3-millimeter spheres. Gastroenterology. 1988 Jun;94(6):1315–1325. doi: 10.1016/0016-5085(88)90669-5. [DOI] [PubMed] [Google Scholar]
  11. Meyer J. H., Ohashi H., Jehn D., Thomson J. B. Size of liver particles emptied from the human stomach. Gastroenterology. 1981 Jun;80(6):1489–1496. [PubMed] [Google Scholar]
  12. Mundlos S., Rhodes J. B., Hofmann A. F. The cholesteryl octanoate breath test: a new procedure for detection of pancreatic insufficiency in the rat. Pediatr Res. 1987 Sep;22(3):257–261. doi: 10.1203/00006450-198709000-00004. [DOI] [PubMed] [Google Scholar]
  13. Regan P. T., Malagelada J. R., DiMagno E. P., Glanzman S. L., Go V. L. Comparative effects of antacids, cimetidine and enteric coating on the therapeutic response to oral enzymes in severe pancreatic insufficiency. N Engl J Med. 1977 Oct 20;297(16):854–858. doi: 10.1056/NEJM197710202971603. [DOI] [PubMed] [Google Scholar]
  14. Regan P. T., Malagelada J. R., Dimagno E. P., Go V. L. Rationale for the use of cimetidine in pancreatic insufficiency. Mayo Clin Proc. 1978 Feb;53(2):79–83. [PubMed] [Google Scholar]
  15. SCHWABE A. D., BENNETT L. R., BOWMAN L. P. OCTANOIC ACID ABSORPTION AND OXIDATION IN HUMANS. J Appl Physiol. 1964 Mar;19:335–337. doi: 10.1152/jappl.1964.19.2.335. [DOI] [PubMed] [Google Scholar]
  16. Siegel J. A., Urbain J. L., Adler L. P., Charkes N. D., Maurer A. H., Krevsky B., Knight L. C., Fisher R. S., Malmud L. S. Biphasic nature of gastric emptying. Gut. 1988 Jan;29(1):85–89. doi: 10.1136/gut.29.1.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Smith H. J., Feldman M. Influence of food and marker length on gastric emptying of indigestible radiopaque markers in healthy humans. Gastroenterology. 1986 Dec;91(6):1452–1455. doi: 10.1016/0016-5085(86)90200-3. [DOI] [PubMed] [Google Scholar]
  18. Stead R. J., Skypala I., Hodson M. E. Treatment of steatorrhoea in cystic fibrosis: a comparison of enteric-coated microspheres of pancreatin versus non-enteric-coated pancreatin and adjuvant cimetidine. Aliment Pharmacol Ther. 1988 Dec;2(6):471–482. doi: 10.1111/j.1365-2036.1988.tb00720.x. [DOI] [PubMed] [Google Scholar]
  19. Zentler-Munro P. L., Fine D. R., Batten J. C., Northfield T. C. Effect of cimetidine on enzyme inactivation, bile acid precipitation, and lipid solubilisation in pancreatic steatorrhoea due to cystic fibrosis. Gut. 1985 Sep;26(9):892–901. doi: 10.1136/gut.26.9.892. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES