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. 2000 Jan;46(1):52–57. doi: 10.1136/gut.46.1.52

13C-egg white breath test: a non-invasive test of pancreatic trypsin activity in the small intestine

P Evenepoel 1, M Hiele 1, B Geypens 1, K Geboes 1, P Rutgeerts 1, Y Ghoos 1
PMCID: PMC1727771  PMID: 10601055

Abstract

BACKGROUND—The recent availability of egg white protein highly enriched with 13C has allowed breath test technology to be adapted for the study of protein digestion and absorption. Pancreatic trypsin is considered to be the key enzyme in the proteolytic cascade.
AIM—To evaluate trypsin activity in the small intestine of healthy volunteers and patients with pancreatic disease by a recently developed 13C-egg white breath test.
METHODS—A total of 48 healthy volunteers and 30 patients with pancreatic disease were studied after ingestion of a test meal consisting of 22 g 13C-labelled egg protein. Breath samples were taken before and after ingestion of the meal and analysed for 13CO2 concentration. Moreover, pancreatic trypsin output after maximal stimulation was measured in 13 patients and nine healthy volunteers.
RESULTS—The six hour cumulative 13CO2 excretion in breath was significantly lower in patients than controls (mean (SEM): 6.23 (0.82)% v 19.16 (0.58)%, p<0.0001). An excellent correlation was found between the six hour cumulative 13CO2 excretion and trypsin activity after maximal pancreatic stimulation.
CONCLUSION—The non-invasive 13C-egg white breath test is promising as an indirect pancreatic proteolytic function test.


Keywords: breath test; pancreatic disease; trypsin; protein; assimilation

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Figure 1  .

Figure 1  

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Rate of 13CO2 excretion (in percentage of dose per hour) after ingestion of 22 g 13C-labelled egg white protein by normal subjects (n = 48) and patients with pancreatic disease (n = 30). Values are mean (SEM).

Figure 2  .

Figure 2  

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Individual values for six hour cumulative percentage of 13CO2 after ingestion of 22 g 13C-labelled egg white protein by normal subjects (n = 48), patients with pancreatic disease who underwent gastrointestinal surgery (n = 9), and patients with pancreatic disease who did not undergo gastrointestinal surgery (n = 21).

Figure 3  .

Figure 3  

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Relation between pancreatic trypsin output after stimulation and the assimilation of egg white protein, measured by the six hour cumulative percentage of 13CO2. T = trypsin activity (kU/h); %dc6h = percentage of administered dose of 13C recovered in breath over six hours.

Figure 4  .

Figure 4  

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Recovery of 13CO2 and L-[1-13C]leucine in breath and plasma after ingestion of an egg protein meal labelled with L-[1-13C]leucine in healthy volunteers (n = 6) and patients with pancreatic disease (n = 2).

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