Toward office-based measurement of gastric emptying in symptomatic diabetics using [13C]octanoic acid breath test.
OBJECTIVE
Current methods for measuring gastric emptying by breath test require sampling over several hours and are too inaccurate for clinical use. The aim of this study was to develop an office-based method for measuring gastric emptying of solids in patients with diabetes using a [13C]octanoic acid breath test.


METHODS
In 22 symptomatic diabetic patients (17 insulin-dependent diabetes, 5 non-insulin-dependent diabetes) and 6 controls, we simultaneously measured gastric emptying of an egg meal (420 kcal) by scintigraphy and [13C]octanoic acid breath test. Conventional (nonlinear) methods for scintigraphic and [13C]octanoic acid breath test emptying and generalized linear regression method to predict scintigraphic half-life (t(1/2)) using four breath samples obtained during the first 3 h.


RESULTS
Despite 8 h of breath sampling, the t(1/2) estimate using the conventional method was markedly different from the scintigraphic value (delta t(1/2): median, 113 min; range, 19-282 min). The generalized linear model (using samples at baseline, 30, and 120 or 150 min) yielded predicted scintigraphic tLAG and t(1/2) that were more accurate than the conventional method; mean standard deviations of differences were 16 and 27 min, respectively. Breath test correctly assessed normal or prolonged emptying in 21 of 22 patients.


CONCLUSIONS
The [13C]octanoic acid breath test can be simplified to measure gastric tLAG and t(1/2) and can be expected to correctly identify normal t(1/2) in symptomatic diabetics. Further refinement of the model will need to include studies of patients with markedly delayed t(1/2).
Lee
J S
JS
Gastroenterology Research Unit, Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Camilleri
M
M
Zinsmeister
A R
AR
Burton
D D
DD
Choi
M G
MG
Nair
K S
KS
Verlinden
M
M
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001944:Breath Tests; D002210:Caprylates; D002250:Carbon Radioisotopes; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012016:Reference Values; D013671:Technetium Tc 99m Sulfur Colloid
D002210:Caprylates; D002250:Carbon Radioisotopes; D013671:Technetium Tc 99m Sulfur Colloid; C031492:octanoic acid