Skip to main content
PMC home page
Gut logoLink to Gut
. 1996 Nov;39(5):668–674. doi: 10.1136/gut.39.5.668

Exocrine pancreatic insufficiency: accuracy and clinical value of the uniformly labelled 13C-Hiolein breath test.

B Lembcke 1, B Braden 1, W F Caspary 1
PMCID: PMC1383389  PMID: 9026480

Abstract

BACKGROUND AND AIMS: The 13C-Hiolein breath test (98% [U-13C] labelled long chain triglyceride mixture (highly labelled triolein) was evaluated as a non-invasive, non-radioactive test for exocrine pancreatic insufficiency. Accuracy and clinical validity were examined with reference to both the secretin pancreozymin test and faecal fat analysis. METHODS: A secretin pancreozymin test and faecal fat analysis were performed in 46 patients, 30 with exocrine pancreatic insufficiency and 16 with normal pancreatic function. In all of these patients and in seven healthy volunteers (controls), a 13C-Hiolein breath test was performed using 2 mg/kg [U-13C] labelled Hiolein with a standard risk snack (1.5 g/kg; 25% fat). 13CO2/12CO2 enrichment in the exhaled breath was measured by isotope ratio mass spectrometry. RESULTS: In patients with pancreatic steatorrhoea the 13CO2 response was below the 95% confidence interval of 13CO2 exhalation in the controls. These responses were also diminished (p < 0.001) compared with patients with impaired lipase output but normal fat excretion and with disease as well as healthy controls. There was a linear correlation between stimulated lipase output and the ratio of lipase output/13CO2 response (r = 0.95). Among the 40 patients in whom direct pancreatic function testing was clinically indicated, the sensitivity of the 13C-Hiolein test for detecting steatorrhoea was 91.7%, with a specificity of 85.7%. CONCLUSIONS: In patients with pancreatic disease the 13C-Hiolein breath test reflects impaired lipase output and indicates decompensated lipolysis. The 13C-Hiolein breath test is a convenient alternative to faecal fat analysis.

Full text

PDF
670

Selected References

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

  1. Benini L., Caliari S., Guidi G. C., Vaona B., Talamini G., Vantini I., Scuro L. A. Near infrared spectrometry for faecal fat measurement: comparison with conventional gravimetric and titrimetric methods. Gut. 1989 Oct;30(10):1344–1347. doi: 10.1136/gut.30.10.1344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Braden B., Adams S., Duan L. P., Orth K. H., Maul F. D., Lembcke B., Hör G., Caspary W. F. The [13C]acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals. Gastroenterology. 1995 Apr;108(4):1048–1055. doi: 10.1016/0016-5085(95)90202-3. [DOI] [PubMed] [Google Scholar]
  3. Braden B., Haisch M., Duan L. P., Lembcke B., Caspary W. F., Hering P. Clinically feasible stable isotope technique at a reasonable price: analysis of 13CO2/12CO2-abundance in breath samples with a new isotope selective-nondispersive infrared spectrometer. Z Gastroenterol. 1994 Dec;32(12):675–678. [PubMed] [Google Scholar]
  4. CREUTZFELDT W. FUNKTIONSDIAGNOSTIK BEI ERKRANKUNGEN DES EXOKRINEN PANKREAS. Verh Dtsch Ges Inn Med. 1964;70:781–801. [PubMed] [Google Scholar]
  5. 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]
  6. DiMagno E. P., Go V. L., Summerskill W. H. Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973 Apr 19;288(16):813–815. doi: 10.1056/NEJM197304192881603. [DOI] [PubMed] [Google Scholar]
  7. Ghoos Y. F., Vantrappen G. R., Rutgeerts P. J., Schurmans P. C. A mixed-triglyceride breath test for intraluminal fat digestive activity. Digestion. 1981;22(5):239–247. doi: 10.1159/000198663. [DOI] [PubMed] [Google Scholar]
  8. Haycock G. B., Schwartz G. J., Wisotsky D. H. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr. 1978 Jul;93(1):62–66. doi: 10.1016/s0022-3476(78)80601-5. [DOI] [PubMed] [Google Scholar]
  9. Hiele M., Ghoos Y., Rutgeerts P., Vantrappen G. Starch digestion in normal subjects and patients with pancreatic disease, using a 13CO2 breath test. Gastroenterology. 1989 Feb;96(2 Pt 1):503–509. doi: 10.1016/0016-5085(89)91577-1. [DOI] [PubMed] [Google Scholar]
  10. Kerlin P., Wong L., Harris B., Capra S. Rice flour, breath hydrogen, and malabsorption. Gastroenterology. 1984 Sep;87(3):578–585. [PubMed] [Google Scholar]
  11. Lankisch P. G., Brauneis J., Otto J., Göke B. Pancreolauryl and NBT-PABA tests. Are serum tests more practicable alternatives to urine tests in the diagnosis of exocrine pancreatic insufficiency? Gastroenterology. 1986 Feb;90(2):350–354. [PubMed] [Google Scholar]
  12. Lankisch P. G., Creutzfeldt W. Effect of synthetic and natural secretin on the function of the exocrine pancreas in man. Digestion. 1981;22(2):61–65. doi: 10.1159/000198596. [DOI] [PubMed] [Google Scholar]
  13. Lankisch P. G. Exocrine pancreatic function tests. Gut. 1982 Sep;23(9):777–798. doi: 10.1136/gut.23.9.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lankisch P. G., Otto J., Brauneis J., Hilgers R., Lembcke B. Detection of pancreatic steatorrhea by oral pancreatic function tests. Dig Dis Sci. 1988 Oct;33(10):1233–1236. doi: 10.1007/BF01536672. [DOI] [PubMed] [Google Scholar]
  15. Lembcke B., Braden B., Stein J. Diagnostik der Steatorrhoe. Z Gastroenterol. 1994 May;32(5):256–261. [PubMed] [Google Scholar]
  16. Mundlos S., Kühnelt P., Adler G. Monitoring enzyme replacement treatment in exocrine pancreatic insufficiency using the cholesteryl octanoate breath test. Gut. 1990 Nov;31(11):1324–1328. doi: 10.1136/gut.31.11.1324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Murphy M. S., Eastham E. J., Nelson R., Aynsley-Green A. Non-invasive assessment of intraluminal lipolysis using a 13CO2 breath test. Arch Dis Child. 1990 Jun;65(6):574–578. doi: 10.1136/adc.65.6.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Newcomer A. D., Hofmann A. F., DiMagno E. P., Thomas P. J., Carlson G. L. Triolein breath test: a sensitive and specific test for fat malabsorption. Gastroenterology. 1979 Jan;76(1):6–13. [PubMed] [Google Scholar]
  19. Niederau C., Grendell J. H. Diagnosis of chronic pancreatitis. Gastroenterology. 1985 Jun;88(6):1973–1995. doi: 10.1016/0016-5085(85)90029-0. [DOI] [PubMed] [Google Scholar]
  20. Vantrappen G. R., Rutgeerts P. J., Ghoos Y. F., Hiele M. I. Mixed triglyceride breath test: a noninvasive test of pancreatic lipase activity in the duodenum. Gastroenterology. 1989 Apr;96(4):1126–1134. doi: 10.1016/0016-5085(89)91632-6. [DOI] [PubMed] [Google Scholar]
  21. Watkins J. B., Klein P. D., Schoeller D. A., Kirschner B. S., Park R., Perman J. A. Diagnosis and differentiation of fat malabsorption in children using 13C-labeled lipids: trioctanoin, triolein, and palmitic acid breath tests. Gastroenterology. 1982 May;82(5 Pt 1):911–917. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES