13C-egg white breath test: a non-invasive test of pancreatic trypsin activity in the small intestine.
BACKGROUND
The recent availability of egg white protein highly enriched with (13)C 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.


OBJECTIVE
To evaluate trypsin activity in the small intestine of healthy volunteers and patients with pancreatic disease by a recently developed (13)C-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 (13)C-labelled egg protein. Breath samples were taken before and after ingestion of the meal and analysed for (13)CO(2) concentration. Moreover, pancreatic trypsin output after maximal stimulation was measured in 13 patients and nine healthy volunteers.


RESULTS
The six hour cumulative (13)CO(2) 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 (13)CO(2) excretion and trypsin activity after maximal pancreatic stimulation.


CONCLUSIONS
The non-invasive (13)C-egg white breath test is promising as an indirect pancreatic proteolytic function test.
Evenepoel
P
P
Department of Medicine, Division of Gastroenterology and Gastrointestinal Research Centre, University Hospital Leuven, B-3000 Leuven, Belgium.
Hiele
M
M
Geypens
B
B
Geboes
K P
KP
Rutgeerts
P
P
Ghoos
Y
Y
D000328:Adult; D000368:Aged; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D004063:Digestion / Q000502:physiology; D004386:Duodenum / Q000201:enzymology*; D004527:Egg Proteins; D005260:Female; D006801:Humans; D007930:Leucine / Q000097:blood; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000201:enzymology* / Q000503:physiopathology; D014357:Trypsin / Q000378:metabolism*
D002247:Carbon Isotopes; D004527:Egg Proteins; D014357:Trypsin; D007930:Leucine