title: A modified ¹³C-mixed triglyceride breath test detects moderate pancreatic exocrine insufficiency.
abstract: OBJECTIVE
  The noninvasive ¹³C-mixed triglyceride breath test (¹³C-MTG-T) has been shown to diagnose severe pancreatic exocrine insufficiency reliably. We hypothesized that sensitivity of the test could be increased by strict limitation of physical activity, correction for gastric emptying velocity, and/or increased lipid dose.
  
  
  METHODS
  In 10 healthy volunteers and 9 patients with suspected pancreatic disease, a secretin test, a modified ¹³C-MTG-T (250 mg ¹³C-MTG, 26 g fat, breath samples over 8 hours), and a ¹³C-octanoic acid gastric emptying test were performed. Subjects remained strictly seated during breath testing.
  
  
  RESULTS
  Intravenously administered secretin 1 U/kg·h stimulated outputs of all enzymes significantly. Mean basal and stimulated enzyme outputs were similar in patients and healthy controls; however, compared with normal values, 5 patients and 1 control had moderately decreased lipase output. Cumulative 4-, 6-, and 8-hour ¹³C exhalation was significantly lower in patients than in controls. Sensitivity of ¹³C-MTG-T (6-h cumulative ¹³C exhalation <27% of dose) for detection of decreased lipase output was 100%; specificity was 92%. Gastric emptying parameters were similar in patients and controls, and correction for these did not improve accuracy of ¹³C-MTG-T.
  
  
  CONCLUSIONS
  The modified ¹³C-MTG-T detects moderate pancreatic exocrine insufficiency.
authors.affiliation: Department of Internal Medicine, Israelitic Hospital in Hamburg, Academic Hospital of the University of Hamburg, Hamburg, Germany. keller@ik-h.de
authors.forename: Jutta
authors.initials: J
authors.lastname: Keller
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brückel
authors.forename: Christine
authors.initials: C
authors.lastname: Jahr
authors.forename: Peter
authors.initials: P
authors.lastname: Layer
mesh_terms: D000328:Adult; D000368:Aged; D001944:Breath Tests / Q000379:methods; D002210:Caprylates; D002247:Carbon Isotopes; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D008049:Lipase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D015203:Reproducibility of Results; D012633:Secretin; D012680:Sensitivity and Specificity; D014280:Triglycerides
chemical_list: D002210:Caprylates; D002247:Carbon Isotopes; D014280:Triglycerides; D012633:Secretin; D008049:Lipase; C031492:octanoic acid