title: Measurement of gastric emptying by 13C-octanoic acid breath test versus scintigraphy in diabetics.
abstract: In this prospective study, we compared the assessment of gastric emptying by the 13C-octanoic acid breath test to gastric emptying scintigraphy in diabetics. We also examined the relationship between gastric emptying parameters and gastric symptoms and cardiovascular autonomic function. The 13C-octanoic acid breath test and scintigraphy were performed simultaneously in 24 diabetics with a solid test meal (1 egg, doubly labelled with 91 mg 13C-octanoic acid and 50 MBq 99mTechnetium-Nanocoll, 60 g white bread, 5 g margarine and 150 ml water). At fifteen-minute intervals, breath samples were taken over 4 hours and examined by mass spectrometry. In parallel, scintigraphy was performed for 2 hours at one minute intervals. Using breath test data, gastric emptying half time (t (1/2) ), lag-phase (t lag ) and gastric emptying coefficient (GEC) were calculated. Subsequently, the correlation of these results with the equivalent data from scintigraphy were determined employing a regression method. To detect a cardiovascular autonomic neuropathy, a 24-h ECG recording was performed. The prevalence of gastrointestinal symptoms in our collective was assessed by a standardized questionnaire. There was a highly significant positive correlation of both 13C-octanoic acid breath test t (1/2) and scintigraphic t (1/2) (r = 0.8257; p < 0.0001) and 13C-octanoic acid breath test t lag and scintigraphic t lag (r = 0.6302; p < 0.001). The sensitivity of the 13C-octanoic acid breath test was 1 and the specificity was 0.73. In our study, there was no significant association of cardiovascular and gastrointestinal autonomic neuropathy. Furthermore, there was no significant relationship between the prevalence of gastrointestinal symptoms and gastric emptying disorders. We conclude that the 13C-octanoic acid breath test represents a suitable method to measure disordered gastric emptying in diabetics due to its highly significant positive correlation to scintigraphy and due to its validity. It is not possible to predict diabetic gastroparesis on the basis of other autonomic function disorders or because of dyspeptic symptoms.
authors.affiliation: Innere Medizin IV, Medizinische Klinik IV, Klinikum der Universität Heidelberg. alexandra.zahn@med.uni-heidelberg.de
authors.forename: A
authors.initials: A
authors.lastname: Zahn
authors.forename: C-D
authors.initials: CD
authors.lastname: Langhans
authors.forename: S
authors.initials: S
authors.lastname: Hoffner
authors.forename: U
authors.initials: U
authors.lastname: Haberkorn
authors.forename: D
authors.initials: D
authors.lastname: Rating
authors.forename: M
authors.initials: M
authors.lastname: Haass
authors.forename: P
authors.initials: P
authors.lastname: Enck
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
authors.forename: A
authors.initials: A
authors.lastname: Rühl
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001944:Breath Tests; D002210:Caprylates; D002247:Carbon Isotopes; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000175:diagnosis* / Q000503:physiopathology; D006321:Heart / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D013270:Stomach / Q000294:innervation*
chemical_list: D002210:Caprylates; D002247:Carbon Isotopes; C031492:octanoic acid