An attempt was made to evaluate the diagnostic effectiveness of the ¹⁴CO₂-tripalmitin breath test in the screening or diagnosis of fat malabsorption. The differential absorption of ¹⁴C-tripalmitin and palmitic acid was evaluated in the diagnosis of pancreatic insufficiency. 24 controls, 13 patients with steatorrhea and 6 with pancreatic disease (4 of them with insufficiency) were studied. 81 breath tests were performed using 75 ml sour cream as a carrier. In 11 cases the ¹⁴C-tripalmitin test was repeated using 27 g corn oil as carrier. Both the ¹⁴C-tripalmitin and ¹⁴C-palmitic acid breath tests failed to provide any discrimination between normals and patients with fat malabsorption. Variation in type and amount of the carrier fat did not alter these results. ¹⁴C-tripalmitin absorption was distinctly abnormal in the patients with pancreatic insufficiency. The differential absorption of ¹⁴C-tripalmitin and ¹⁴C-ρalmitic acid provided an even better separation between patients with and without pancreatic disease. In contrast to some other investigators we did not find the ¹⁴C-tripalmitin and/or palmitic acid breath tests useful in the diagnosis or screening of fat malabsorption. These tests appear promising in the diagnosis of pancreatic disease.

The cholyl glycine-1-¹⁴C breath test was evaluated in a variety of gastrointestinal disorders. 138 tests were performed in 106 patients. Methods of data expression were evaluated and the cumulative 8-hour value was used. In 27 control patients the upper limit of the normal was found to be 78. A good correlation was found between the peak values and the cumulative 8-hour values (r = 0.95, p < 0.01). The reproducibility of the test was good (r = 0.985, p < 0.05). Abnormal results were found in 12 out of 13 cases with resection of the ileum and 11 out of 14 cases with Crohn’s disease of the distal small bowel. The test was normal in cases with diseases of the proximal small bowel (celiac, Whipple’s and Crohn’s diseases). The test was also normal in patients with colitis. It was abnormal in some of the cases after cholecystectomy and in most cases with carcinoma of the pancreas. The breath test was useful in monitoring the results of treatment in bacterial overgrowth of the small bowel. False negative results were observed after antibiotic treatment. The method seems to be more sensitive than the Schilling test in diagnosing disease of the distal small bowel.