13C-starch breath test--comparative clinical evaluation of an indirect pancreatic function test.
The clinical relevance of the 13C-starch breath test was evaluated in comparison to the secretin-caerulein test as the "gold standard" of pancreatic function testing, fecal elastase concentration, and fecal chymotrypsin activity in 30 patients with mild (n = 15) or severe (n = 15) exocrine pancreatic insufficiency. 23 patients with gastrointestinal diseases of non-pancreatic origin and 31 healthy volunteers served as controls. 50 g of natural starch of maize were orally administered after a 12-h fast and breath samples were taken before and in 30 min intervals for five hours after oral ingestion and the increase of 13C/12C-isotopic ratio was analyzed by mass spectrometry. Specificity of fecal elastase (93%) and fecal chymotrypsin (93%) for impaired pancreatic function were much higher compared to the various parameters of the 13C-starch breath test (69-74%). Sensitivities of the 13C-starch breath test for all and separately for mild and severe exocrine pancreatic insufficiency were higher (total 70-77%) compared to fecal chymotrypsin (total 60%), but lower compared to fecal elastase (total 93%). With regard to the higher sensitivity and specificity, the higher practicability, and the lower costs determination of fecal elastase concentrations is superior to the 13C-starch breath test and therefore remains to be the most reliable indirect pancreatic function test available today.
Löser
C
C
I. Medical Department, Christian-Albrechts-University of Kiel.
Möllgaard
A
A
Aygen
S
S
Hennemann
O
O
Fölsch
U R
UR
D000328:Adult; D001944:Breath Tests / Q000379:methods*; D002250:Carbon Radioisotopes; D002108:Ceruletide; D002908:Chronic Disease; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D010195:Pancreatitis / Q000175:diagnosis; D012016:Reference Values; D012633:Secretin; D012680:Sensitivity and Specificity; D013213:Starch
D002250:Carbon Radioisotopes; D012633:Secretin; D002108:Ceruletide; D013213:Starch