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. 2021 Jun 14;9(5):598–625. doi: 10.1002/ueg2.12099

TABLE 8.

Established test protocols for 13C‐MTGBT in adults and children

Age Test meal Breath sampling Endpoints and normal values Validity Remarks
Vantrappen et al. 1989 127 Adults 100 g of toast with 0.25 g of butter per kg of body weight, plus 16 mg 13 C ‐MTG per gram of butter At baseline and at 30 min intervals for 6 h pp Cumulative 13C‐recovery, normal (estimated from fig 4: Lowest value obtained in HC): >23% of dose

  • For detection of PEI (decreased lipase output):

  • SENS 89%, SPEC 81%

  • PPV 63%

  • NPV 95% (control pts with nonpancreatic steatorrhea included)

  • 29 pts with pancreatic disease, controls: 25 healthy subjects + 22 pts with nonpancreatic steatorrhea

  • comparison with both, stimulated duodenal lipase output (reference standard for pancreatic secretion) and quantitative fecal fat (reference standard for steatorrhea)

  • Effect of PERT demonstrated in subgroup of pancreatic pts
Dominguez‐Munoz et al. 2015 132 Adults

  • 40 g bread, 20 g butter 200 ml water, 13C‐MTG spread on butter (total fat content 16 g) plus 250 mg 13C‐MTG

  • 10 mg metoclopramide 20 min before meal ingestion

 At baseline and at 30 min intervals for 6 h pp Cumulative 13C‐recovery, normal >29% of dose (>19% for 4 h test duration)

  • SENS 93%, SPEC 92%

  • ACC 92% (4h‐test is associated with slightly lower diagnostic ACC.: SENS 91%, SPEC 89%)

 Developed using quantitative fecal fat (reference standard for steatorrhea) for comparison in healty volunteers (N = 10) and chronic pancreatitis patients with (N = 16) or without (N = 4) PEI, validated in 78 pts with advanced CP, also shown to be of value for monitoring of PERT efficacy, and to correlate with the nutritional status and the severity of chronic pancreatitis
Keller et al. 2011 12 Adults Two slices of white bread, 20 g butter, 30 g chocolate cream (31 g fat/100 g) mixed with 250 mg 13 C‐MTG (total fat content 26 g) At baseline and at 30 min intervals for 6 h pp Cumulative 13C‐recovery, normal >26.8% of dose SENS 100%, SPEC 92% versus secretin test Validated using secretin test (reference standard for pancreatic secretion) for comparison in HC and patients with pancreatic disease (N = 19), also detects mild and moderate PEI
Keller et al. 2014 14 Adults Two slices of white bread, 20 g butter, 30 g chocolate cream (31 g fat/100 g) mixed with 250 mg 13 C‐MTG (total fat content 26 g) At baseline and at 30 min intervals for 4 h pp Cumulative 13C‐recovery, normal >13.8% of dose SENS 88% SPEC 94%, versus 6 h test version Evaluated in 200 pts undergoing both, 13C‐MTGT and 13C‐GEBT. More convenient, but decreasing duration of the test associated with lower diagnostic accuracy. Tests with less than 4 h duration are markedly influenced by gastric emptying time
Van Dijk‐van Aalst et al. 2001 146 12 premature infants, 12 full‐term infants (1–6 months), 20 children (3–10 years), 20 teenagers (11–17 years) Infants: Formula with low 13C content (e.g., NAN1 (Nestlé), Pre‐Aptamil (Milupa) with 100 mg 13 C‐MTG and 1 g polyethylene‐glycol 3350; > 3 years: slice of white bread with 5 g butter and 15 g chocolate paste, mixed with 250 mg 13 C‐MTG, 100 ml whole‐fat milk Two samples at baseline, further samples at 15 min intervals for 6 h pp

  • Cumulative 6h‐13CO2‐excretion (% of dose administered) mean ± SD: Premature infants: 23.9 ± 5.2%

  • Full‐term infants: 31.9 ± 7.7%

  • Children: 32.5 ± 5.3%

  • Teenagers: 28.0 ± 5.4%

 ‐ Mean value for healthy adults: 35.6%, lower limit of normal 22.8%

Abbreviations: 13C‐GEBT, 13C‐gastric emptying breath test; 13C‐MTG, mixed triglycerides; 13C‐MTGBT, 13C‐mixed triglyceride breath test; ACC, accuracy; HC, healthy controls; PEI, pancreatic exocrine insufficiency; PERT, pancreas enzyme replacement therapy; pp, postprandially; SENS, sensitivity; SPEC, specificity.

[Corrections added on June 28, 2021 after first online publication: Typos have been corrected in Table 8].