[13C]0ctanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients: Validation and relationship to gastric symptoms and cardiovascular autonomic function

Abstract

Since there is a need for a widely applicable non-invasive test to assess gastric emptying in diabetic patients, we evaluated the sensitivity, specificity, and reproducibility of the [13C]octanoic acid breath test as compared with scintigraphy. Moreover, we examined the relationship between the breath test indices and gastric symptoms, cardiovascular autonomic function, and metabolic parameters. Forty healthy control subjects and 34 diabetic patients were studied. Three indices of gastric emptying, assessed by the breath test, were computed: half-emptying time (t1/2breath), gastric emptying coefficient (GEC), and lag phase. Furthermore, the half-emptying time, measured by scintigraphy (t1/2scint), was calculated and gastric symptoms and cardiovascular autonomic neuropathy (CAN) were scored. The coefficients of variation of day-to-day reproducibility in 10 healthy subjects were 29.6% for t1/2breath, 7.4% for GEC, and 46.5% for lag phase. An abnormal delay for t1/2scint (> 100 min) or t1/2breath (> 200 min) was noted in 12 patients. Based on the results for t1/2scint, the sensitivity of t1/2breath and GEC was 75% and the specificity was 86%. Both t1/2breath (rs = 0.523; p < 0.05) and GEC (r2 = -0.594; p < 0.05) were significantly associated with the gastric symptom score. A significant relationship to the CAN score was demonstrated for t1/2breath (rs = 0.448; p < 0.05), GEC (rs = -0.467; p < 0.05), and t1/2scint (rs = 0.602; p < 0.05). There were no significant associations of the breath test indices with the blood glucose levels during the test, HbA1c, age, and duration of diabetes. In patients with abnormal t1/2scint (n = 12) not only was t1/2breath significantly prolonged and GEC reduced, but also the scores of CAN and gastric symptoms were significantly increased as compared with those who had a normal t1/2scint (n = 22). We conclude that the [13C]octanoic acid breath test represents a suitable measure of delayed gastric emptying in diabetic patients which is associated with the severity of gastric symptoms and CAN but not affected by the blood glucose level.

Effects of Epalrestat, an Aldose Reductase Inhibitor, on Diabetic Neuropathy and Gastroparesis

“…However, it has been reported that examination of autonomic nervous functions and glycosylated hemoglobin are not useful for predicting the occurrence of diabetic gastroparesis (10)(11)(12), and that the manifestation of subjective symptoms is not significantly correlated with the severity of visceral neuropathy. Other studies, however, have reported that the occurrence of diabetic gastroparesis was closely related to the results of heart rate variability analysis (13,14). These findings suggest that the treatment of diabetic gastroparesis should be initiated from the early stage and before the appearance of subjective symptoms, based on the results of an easy and simple assessment of gastrointestinal motility.…”

“…However, Nakamuraet al (13) reported that coefficients of variation (CVr.r) obtained by time-domain analysis of heart rate variability were closely correlated with gastric motility evaluated by the acetoaminophen and isotope methods. Furthermore, Ziegler et al (14) reported that gastric motility evaluated by the [13C]octanoic acid breath test was correlated with dysautonomia evaluated by CVR-R.However, few studies have reported on the relationship betweenthe spectral analytical parameters of heart rate variability and gastric motility. In the present study, HF power, an index of parasympathetic nerve functions, was significantly correlated with peak power values of EGGand gastric motility at a frequency between 2.4 and 3.6 cpm.…”

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

“…Cross-sectional studies using scintigraphic techniques to measure gastric emptying have shown delayed gastric emptying in patients with diabetes varying from 30 to 60% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, there are several important limitations to these studies.…”

Noninvasive 13C-octanoic acid breath test shows delayed gastric emptying in patients with amyotrophic lateral sclerosis

“…The 13 C-octanoic acid breath test is a valid and well-reproducible method to measure gastric emptying [13][14][15]. It has been shown that gastric emptying measured by breath tests correlated well with scintigraphic studies [6,13,16]. Breath sample collection for the 13 CO 2 breath test does not inconvenience patients and can be performed even in patients with advanced disease.…”