Effects of postgastric 13C-acetate processing on measurement of gastric emptying: a systematic investigation in health.
Uniform postgastric processing of the gastric emptying (GE) marker 13C-acetate (Ac) is an unverified assumption behind its widespread application to measure GE. This study assessed the postgastric processing of Ac administered by intraduodenal (i.d.) infusion simulating different physiological conditions. 13CO2 in breath was assessed in three groups of six volunteers after i.d. administration of A: Different caloric densities (0.75/1.5/3 kcal min(-1) in a 200 mL meal at constant 1 mg Ac min(-1) simulating a physiological range of nutrient delivery rates; B: different tracer delivery rates (0.5/1.0/2.5 mg Ac min(-1) simulating delayed, normal and increased GE; C1: a 500 mL meal resulting in same marker and caloric delivery compared to protocol A; C2: 50 mL water bolus injections of 12.5/25/50/100 mg Ac and C3 bolus injections of 50 mg Ac in 50/100/200 mL water in randomized order. A: 13CO2 excretion was independent of caloric load (P = 0.59). B: The dynamic of 13CO2 excretion was modulated by tracer elimination which was in turn dependent on the speed of tracer delivery, i.e. with faster deliveries resulting in lower 13CO2 recovery during infusion (P < 0.001). C: Increasing Ac doses resulted in decreased 13CO2 recovery (P < 0.001) over the first hour. 13CO2 recovery kinetics was independent of the volume delivered. This study shows 13C-acetate absorption and metabolism is independent of the volume and caloric delivery of test meals. The 'lag' in estimates of GE derived from 13CO2 breath tests is due to a postgastric, dose-dependent delay to 13CO2 elimination. This can be corrected for in analytical derivations of GE parameters based on 13C-acetate breath test measurements.
Goetze
O
O
Division of Gastroenterology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland. oliver.goetze@usz.ch
Fox
M
M
Kwiatek
M A
MA
Treier
R
R
Schwizer
W
W
Thumshirn
M
M
Fried
M
M
Fruehauf
H
H
D000085:Acetates / Q000493:pharmacokinetics; D000328:Adult; D000465:Algorithms; D002250:Carbon Radioisotopes; D002149:Energy Intake / Q000502:physiology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006262:Health; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism*; D008297:Male; D015233:Models, Statistical; D055815:Young Adult
D000085:Acetates; D002250:Carbon Radioisotopes