13C Breath Tests for the Assessment of Exocrine Pancreatic Function

Braden, Barbara

doi:10.1097/mpa.0b013e3181dbf330

Cited by 19 publications

(10 citation statements)

References 49 publications

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“…Similar results have been seen with the dual‐label Schilling test and fluorescein‐dilaurate (pancreolauryl) test . In contrast, good correlation of test results with fecal fat excretion has been noted with 13 C‐labeled triglyceride breath tests . Unfortunately, these tests are abnormal with any cause of fat malabsorption because production of 13 CO 2 depends not only on hydrolysis but also absorption and metabolism of the labeled fatty acid …”

Section: Diagnosissupporting

confidence: 57%

“…162 In contrast, good correlation of test results with fecal fat excretion has been noted with 13 C-labeled triglyceride breath tests. [167][168][169] Unfortunately, these tests are abnormal with any cause of fat malabsorption because production of 13 CO2 depends not only on hydrolysis but also absorption and metabolism of the labeled fatty acid. 162 At present, there is no single, simple, reliable, and accurate test for pancreatic exocrine insufficiency.…”

Section: Pancreatic Function Testsmentioning

confidence: 99%

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Gastro 2013 APDW/WCOG Shanghai Working Party Report: Chronic diarrhea: Definition, classification, diagnosis

Schiller

Pardi

Spiller

et al. 2013

J of Gastro and Hepatol

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Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.

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Section: Diagnosissupporting

confidence: 57%

Section: Pancreatic Function Testsmentioning

confidence: 99%

Gastro 2013 APDW/WCOG Shanghai Working Party Report: Chronic diarrhea: Definition, classification, diagnosis

Schiller

Pardi

Spiller

et al. 2013

J of Gastro and Hepatol

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“…The hydrolyzed products are absorbed, metabolized, and will eventually reach the pulmonary endothelium where it is released with expiration [102]. There are many breath tests that can measure pancreatic function, but the most sensitive test involves assessing lipase activity as it has been shown to be the first enzyme impaired in pancreatic insufficiency [103]. There are many different test meals to assess lipase activity, all centering on a meal with high triglyceride content.…”

Section: Diagnosis Of Chronic Pancreatitismentioning

confidence: 99%

Chronic Pancreatitis: Current Status and Challenges for Prevention and Treatment

2017

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This paper reviews the current status of our understanding of the epidemiology, diagnosis, and management of the continuum of pancreatic diseases from acute and recurrent acute pancreatitis to chronic pancreatitis and the diseases that are often linked with pancreatitis including diabetes mellitus and pancreatic cancer. In addition to reviewing the current state of the field, we identify gaps in knowledge that are necessary to address to improve patient outcomes in these conditions.

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“…The evaluation of nutrient absorption in the intensive care setting is challenging, and there is a lack of simple, clear‐cut validated bedside tests 26 . The 13 C‐triolein breath test is a reproducible method to measure fat absorption and has been validated in a variety of clinical settings, including in healthy volunteers, 27 postoperative patients, 22 , 24 and patients with exocrine pancreatic insufficiency, including cystic fibrosis 28 , 29 . Other methods to assess fat absorption are associated with significant limitations.…”

Section: Discussionmentioning

confidence: 99%