Preliminary report of the (13)C-mixed triglyceride breath test to assess timing of pancreatic enzyme replacement therapy in children with cystic fibrosis.
Despite guidelines suggesting pancreatic enzyme replacement therapy (PERT) should be taken before or during a meal, it is currently unknown whether this has benefits over administration after a meal in individuals with cystic fibrosis (CF).



18 children with pancreatic insufficient CF were randomised to two (13)C-mixed triglyceride ((13)C-MTG) breath tests to assess lipase activity with PERT administered 10min before and 10min after a meal. Results were expressed as percentage cumulative dose recovered (PCDR) of (13)CO2 and were compared with established values in healthy subjects. Gastric half emptying time (T½) was also assessed by a (13)C-octanoate breath test.



There was no difference in mean PCDR of (13)CO2 between taking PERT before versus after the meal (p=0.68). Eleven subjects had a greater PCDR when PERT was taken before and 7 when PERT was taken after the meal. 6/8 subjects (75%) with a lower than normal PCDR at one time point normalised PCDR when PERT timing was changed. When PERT was taken after the meal, PCDR was higher in normal vs. fast T½ (p=0.04).



Changing PERT timing can result in normalised lipase activity. Gastric emptying rate may influence optimal timing of PERT. Clinical Trial Registration Number - This study was undertaken prior to the registration process being a commonly required practice.
Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia, Australia. Electronic address: natalie.vanderhaak@sa.gov.au.
Natalie
N
van der Haak
Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Julia
J
Boase
Department of Gastroenterology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Geoffrey
G
Davidson
Department of Gastroenterology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Ross
R
Butler
Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
Michelle
M
Miller
Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, Australia.
Billingsley
B
Kaambwa
Department of Gastroenterology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Stamatiki
S
Kritas
D000293:Adolescent; D001944:Breath Tests / Q000379:methods; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D004041:Dietary Fats / Q000378:metabolism; D004334:Drug Administration Schedule; D056947:Enzyme Replacement Therapy / Q000379:methods*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects / Q000502:physiology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008049:Lipase / Q000032:analysis*; D008297:Male; D010179:Pancreas / Q000201:enzymology*; D010186:Pancreatic Function Tests / Q000379:methods; D020799:Pancrelipase / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D014280:Triglycerides / Q000032:analysis / Q000378:metabolism
D004041:Dietary Fats; D005765:Gastrointestinal Agents; D014280:Triglycerides; D020799:Pancrelipase; D008049:Lipase
Cystic fibrosis; Gastric emptying; Lipase activity; Pancreatic enzyme replacement therapy