Development and Diagnostic Accuracy of a Breath Test for Pancreatic Exocrine Insufficiency in Chronic Pancreatitis

Abstract

The optimized ¹³C-mixed triglyceride breath test is an accurate and simple breath test for the diagnosis of PEI in patients with CP, easily applicable to the clinical routine.

Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

“…The 72-h fecal fat test is the gold standard for the quantification of steatorrhea, but it does not detect mild or moderate alterations of pancreatic function, which can be associated with earlier stages of pancreatic disease. Several 13 C-breath tests, including the 13 C-mixed triglyceride (MTG) test, have been developed for evaluating pancreatic exocrine function, but they are associated with greater time consumption than the FE-1 test [20]. Table 1 summarizes the advantages and disadvantages of the currently available pancreatic function tests [3,8,21,22].…”

“…The 13 C-labeled fat is digested by pancreatic lipase, following which it is absorbed, oxidized, and can be detected in exhaled breath as an indirect measure of lipolysis within the small intestine [20]. In a study examining the usefulness of the 13 C-MTG breath test compared with the FE-1 test in patients with CP or following pancreatic surgery, both tests correlated with one another; however, the accuracy rate for clinical symptoms, including clinical steatorrhea, for the FE-1 test (62%) was lower than that for the breath test (88%) [64].…”

Chinese guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency (2018 edition)

“…Indirect tests include the fecal fat test, fecal elastase (FE)‐1 test, the 13 C‐labled mixed triacylglycerol breath test ( 13 C‐MTG‐BT), the urinary N‐benzoyl‐L‐tyrosyl‐p‐aminobenzoic acid test, and the secretin‐stimulated magnetic resonance cholangiopancreatography (s‐MRCP). Compared with the direct test, the indirect tests are inexpensive and easy to perform; however, their sensitivity and specificity are relatively low.…”

“…However, the direct test is limited in clinical practice due to its high cost and invasiveness. 22 Indirect tests include the fecal fat test, fecal elastase (FE)-1 test, the 13 C-labled mixed triacylglycerol breath test ( 13 C-MTG-BT), 23 indirect test; PEI is defined by an FE-1 level <200 μg/g. 24 Elastase-1 is secreted by the pancreas; it is not degraded in the intestine but is excreted completely with the feces.…”

Chronic Pancreatitis in the 21st Century - Research Challenges and Opportunities

“…The documentation of maldigestion with a 72-hour fecal fat analysis is not feasible in the outpatient setting. While breath tests (C 13 or C 14 mixed triglyceride) of digestion have shown some promise 32 , they remain largely unavailable. Tests of basal pancreatic secretion of enzymes (fecal elastase or serum trypsin) are prone to error 33 .…”