The 13C-caffeine breath test detects significant fibrosis in patients with nonalcoholic steatohepatitis.
BACKGROUND
The C-caffeine breath test (CBT) is a noninvasive tool for the evaluation of the cytochrome P450 system, implicated in the development of nonalcoholic steatohepatitis.


OBJECTIVE
To apply the CBT to assess the extent of hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD).


METHODS
Twenty-six consecutive patients (mean age 56.1+/-6.85 y, 69.2% women) with NAFLD underwent the CBT, in addition to the clinical and laboratory evaluations and liver biopsy. Ten healthy individuals matched for age served as controls.


RESULTS
Mean delta over baseline values differed significantly between patients and controls (1.51+/-0.9 vs. 2.37+/-0.8 Delta per thousand/mg, respectively) (P=0.01) and were significantly higher in patients with fibrosis stage <2 (Brunt's system) (2.0+/-0.77 vs. 1.3+/-0.9 for stage > or =2, P=0.05). Mean delta over baseline values correlated highly with fibrosis stage (P=0.01), albumin (P=0.007), international normalized ratio (P=0.04), bilirubin (P=0.0008), and platelet count (P=0.0001). On multivariate stepwise logistic regression analysis, CBT was the best predictor of severe fibrosis (stage > or =2) (odds ratio 0.274, 95% confidence interval 0.086-0.872, P=0.028), with an area under the curve of 0.788.


CONCLUSIONS
The CBT is safe and easy to perform. It can reliably predict severe hepatic fibrosis in patients with NAFLD. Further large-scale studies are still needed.
Schmilovitz-Weiss
Hemda
H
Liver Institute and Department of Medicine D, Beilinson Campus Rabin Medical Center, Petah Tiqwa, Israel.
Niv
Yaron
Y
Pappo
Orit
O
Halpern
Marisa
M
Sulkes
Jacklin
J
Braun
Marius
M
Barak
Nir
N
Rotman
Yaron
Y
Cohen
Maya
M
Waked
Amal
A
Tur-Kaspa
Ran
R
Ben-Ari
Ziv
Z
D001944:Breath Tests / Q000379:methods*; D002110:Caffeine / Q000032:analysis*; D002247:Carbon Isotopes; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index
D002247:Carbon Isotopes; D002110:Caffeine