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. 1998 Jan;42(1):81–87. doi: 10.1136/gut.42.1.81

13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency

M Ventrucci 1, A Cipolla 1, G Ubalducci 1, A Roda 1, E Roda 1
PMCID: PMC1726942  PMID: 9505890

Abstract

Background—A non-invasive test for assessment of fat digestion has been developed based on the intraluminal hydrolysis of cholesteryl-[1-13C]octanoate by pancreatic esterase. 
Aims—To determine the diagnostic performance of this breath test in the assessment of exocrine pancreatic function. 
Methods—The test was performed in 20 healthy controls, 22 patients with chronic pancreatic disease (CPD), four with biliopancreatic diversion (BPD), and 32 with non-pancreatic digestive diseases (NPD); results were compared with those of other tubeless tests (faecal chymotrypsin and fluorescein dilaurate test). 
Results—Hourly recoveries of 13CO2 were significantly lower in CPD when compared with healthy controls or NPD. In patients with CPD with mild to moderate insufficiency, the curve of 13CO2 recovery was similar to that of healthy controls, while in those with severe insufficiency it was flat. In three patients with CPD with severe steatorrhoea, a repeat test after pancreatic enzyme supplementation showed a significant rise in 13CO2 recovery. The four BPD patients had low and delayed 13CO2 recovery. Only eight of the 32 patients with NPD had abnormal breath test results. There was a significant correlation between the results of the breath test and those of faecal chymotrypsin, the fluorescein dilaurate test, and faecal fat measurements. For the diagnosis of pancreatic disease using the three hour cumulative 13CO2 recovery test, the sensitivity was 68.2% and specificity 75.0%; values were similar to those of the other two tubeless pancreatic function tests. In seven healthy controls, nine patients with CPD, and nine with NPD a second breath test was performed using Na-[1-13C]octanoate and a pancreatic function index was calculated as the ratio of 13C recovery obtained in the two tests: at three hours this index was abnormal in eight patients with CPD and in three with NPD. 
Conclusion—The cholesteryl-[1-13C]octanoate breath test can be useful for the diagnosis of fat malabsorption and exocrine pancreatic insufficiency. 



Keywords: cholesteryl octanoate breath test; exocrine pancreatic insufficiency; lipid malabsorption; stable isotopes

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Figure 1 .

Figure 1

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Individual values of the results of the cholesteryl-[1-13C]octanoate breath test expressed as cumulative 13CO2 recovery after three and six hours. Horizontal bars indicate median values. Arrows show the variation of a repeat test in two healthy controls and five patients. Inverted triangle, mild to moderate CPD; upright triangle, severe CPD. 


graphic file with name 96778.f2.jpg

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10-90th centile
Controls 0.7-4.4 1.9-9.9 4.0-11.6 3.6-9.6 2.6-8.4 1.4-7.7
NPD 0.2-4.0 0.8-7.1 1.1-9.2 0.9-9.0 0.6-8.3 0.6-6.7
CPD 0.0-2.0 0.1-5.8 0.1-8.1 0.1-7.0 0.1-6.8 0.0-5.6
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Figure 4 .

Figure 4

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Individual hourly time course recovery of 13CO2 after cholesteryl-[1-13C]octanoate breath test in the four patients with biliopancreatic diversion compared with median values of healthy controls (dotted line). 


Figure 5 .

Figure 5

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Individual values of the pancreatic function index (cholesteryl-octanoate/Na-octanoate 13CO2 recovery ratio). Inverted triangle, mild to moderate CPD; upright triangle, severe CPD. 


Figure 3 .

Figure 3

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Relations between the six hour 13CO2 recovery of the cholesteryl-[1-13C]octanoate breath test and faecal chymotrypsin concentration (A), fluorescein dilaurate test results (B), and faecal fat (C). In graph C, the curve was drawn manually and represents the best fit for the points. Inverted triangle, mild to moderate CPD; upright triangle, severe CPD. 


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