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A modified 13 C-mixed triglyceride breath test 13 C -MTGT detects moderate pancreatic exocrine insufficiency noninvasively and reliably, but it requires prolonged breath sampling 6 hours hr. We determined the sensitivity and specificity of shortened breath sampling periods, by comparison with the normal values from 10 healthy volunteers, whom also underwent a secretin test to quantitate pancreatic secretion.
At present, clinicians almost exclusively use the fecal elastase-1 test for measurement of pancreatic exocrine function, although this test has limited sensitivity for mild-to-moderate pancreatic exocrine insufficiency, and despite its limited specificity in patients with diarrhea. In particular, this research project aims to define the optimal way to perform and analyze alternative pancreatic function tests, such as secretin-enhanced magnetic resonance cholangiopancreatography MRCP and 13 C-breath tests, under clinical conditions.
We have shown previously that a modified version of the 13 C-mixed triglyceride breath test 13 C-MTGT detects moderate pancreatic exocrine insufficiency noninvasively and reliably.
The 13 C-MTGT is generally based on the principle that intestinal triglyceride absorption requires prior hydrolysis by pancreatic lipase to produce free fatty acids and mono-acyl-glycerol. These metabolites are absorbed and transported to the liver. Hepatic metabolism subsequently leads to formation of 13 CO 2 that is absorbed into the bloodstream, transported to the lung and exhaled. It has been shown that the increase in 13 CO 2 -concentration in breath correlates with pancreatic lipase secretion.
The optimal parameter for evaluation of pancreatic exocrine function by 13 C-MTGT, reported by various groups including ours, is cumulative 13 CO 2 -exhalation in a percentage of dose administered over 5—8 hours hrs 3 — 6 ; thus, although the 13 C-MTGT is a rather convenient, noninvasive indirect pancreatic function test, its long period of breath sampling and patient immobilization is a major drawback for clinical application. Because digestion of dietary lipids by pancreatic lipase cannot occur before the meal has entered the duodenum, we additionally aimed to investigate whether gastric emptying velocity influences the results of the 13 C-MTGT.
Furthermore, in a subset of patients whom also received a 13 C-octanoic acid breath test 13 C-OAT for measurement of gastric emptying velocity, we tested the influence of gastric emptying on the results of the 13 C-MTGT test. We identified and retrospectively analyzed data from consecutive patients whom underwent a 13 C-MTGT at our institution for clinical reasons, between January and February Such direct tests using hormone stimulation are the most sensitive and specific tests for assessing the pancreatic exocrine reserve; and therefore, are accepted as reference standards.
The data from these subjects have been partially published before. The study protocol for evaluation of pancreatic exocrine function in healthy volunteers was approved by the local ethics committee Ethik-Kommission der Ärztekammer Hamburg, reference number and all subjects gave written informed consent prior to any study-related procedures. This duodenal juice was fractionated in min intervals and we performed analyses of pH, volume, bicarbonate and enzyme outputs, as described previously.
Our tests were performed by three nurses highly experienced in pancreatic function testing and finally, evaluated by a gastroenterologist. A subset of patients additionally underwent a 13 C-OAT for measurement of gastric emptying of solids. Our subjects were instructed to remain seated throughout the test procedures. We did this by testing for whether the established parameter and breath test data obtained over shorter periods of time gave compatible results, indicating either normal or reduced pancreatic exocrine function.
Furthermore, we divided patients with decreased exocrine function, according to the standard parameter, as having exhalation that was: We used 2-tailed Student's t -tests for paired and unpaired data, for statistical analyses and univariate or multivariate linear regression analyses, applying them as appropriate. Of the patients investigated, 19 had incomplete data, so they were excluded from further analysis Figure 1. Breath tests were generally tolerated well by all subjects and no relevant adverse events occurred.
We compared the cumulative 13 C-exhalation in percent of dose administered over the 1- to 6-hr intervals with normal values in these subjects. In patients, our standard parameter for measurement of pancreatic exocrine function that is, 6-hr cumulative 13 C-exhalation was equal to or exceeded Dotted lines mark the lower level of normal; and thus, grey areas mark tests that give compatible results using the standard parameter and the abbreviated test.
Sensitivity and specificity of 5-hr cumulative 13 C-exhalation versus the standard parameter were high Table 1 and Figure 2. The areas marked in different shades of grey represent severely, moderately and mildly impaired intestinal lipolysis.
Broken lines give the lower level of normal for the standard parameter and the result of the abbreviated test. Remarkably, all subjects with more than mildly impaired lipolysis according to the standard parameter were also detected by the abbreviated test. Of these, 19 patients had to be excluded, because they received a different vegetarian test meal or because the time interval between both tests exceeded 4 weeks.
Among the remaining 98 patients, there were 64 women. The mean age of all of these patients was Seven out of these patients had impaired intestinal lipolysis, as their 6-h 13 C-exhalation was below Multivariate linear regression models confirmed there was a consistent association between 13 C-exhalation rates during both tests: These findings indicate there was an association between gastric emptying velocity and the results of the pancreatic function test, particularly if evaluating early postprandial measurements of the 13 C-MTGT; however, cumulative 6-hr 13 C-exhalation during the 13 C-MTGT was similar, for patients with normal or delayed gastric emptying Importantly, even the 4-hr value detected all patients with moderate or severe exocrine insufficiency and more than two-thirds of the patients with mildly impaired intestinal lipolysis.
We had shown previously that in contrast to other noninvasive pancreatic function tests, 1 a modified version of the 13 C-MTGT detects moderate pancreatic exocrine insufficiency reliably. To avoid an increase in overall CO 2 -production that also influences 13 CO 2 -exhalation, subjects need to remain seated during the test procedures 18 ; thus, although the 13 C-MTGT is a rather convenient, noninvasive indirect pancreatic function test, the long period of breath sampling and immobilization is a major drawback for clinical application, so shorter test versions would be highly desirable.
The clinical need for such a test is underlined by the fact that current multinational research agendas explicitly aim to simplify the 13 C-MTGT and so this study has been performed as part of the HaPanEU project Harmonizing diagnosis and therapy of pancreatitis across Europe.
The findings of our present study suggest that for clinical purposes the breath sampling period may be shortened to 4 hours. Cumulative 13 C-exhalation over 5 hours gave almost identical results compared with the standard parameter figure 2 ; however, it would only allow a minor abbreviation of the test. Accordingly, an abbreviated version of the 13 C-MTGT with breath sampling over 4 instead of 6 hours appears to be sufficient for clinical purposes.
Since digestion of dietary lipids by pancreatic lipase cannot occur before the meal has entered the duodenum, we tested the influence of gastric emptying on results of the 13 C-MTGT in a subset of 98 patients who received both, the 13 C-MTGT for measurement of pancreatic exocrine function and a 13 C-OAT for measurement of gastric emptying. Multivariate linear regression analyses revealed a significant association between the parameters of the 13 C-MTGT and gastric emptying velocity that was particularly strong early postprandially.
Accordingly, the influence of gastric emptying on results of the 13 C-MTGT probably precludes a further abbreviation of the breath sampling period to less than 4 hours. Whether the modified 13 C-MTGT may give false positive results in patients with lipid malabsorption due to other etiologies than pancreatic exocrine insufficiency 19 deserves further studies. The influence of gastric emptying on early postprandial results of the 13 C-MTGT precludes a further reduction of the breath sampling period.
Importantly, the abbreviated test still detects all patients with moderate or severe exocrine insufficiency and more than two-thirds of the patients with mildly impaired intestinal lipolysis. Thus, in line with current multinational research agendas such as the HaPanEU project, we showed that the 13 C-MTGT can be abbreviated and still represents a reliable, noninvasive pancreatic function test. National Center for Biotechnology Information , U. United European Gastroenterol J. Received Feb 24; Accepted May Abstract Background A modified 13 C-mixed triglyceride breath test 13 C -MTGT detects moderate pancreatic exocrine insufficiency noninvasively and reliably, but it requires prolonged breath sampling 6 hours hr.
Breath test, diagnostic testing, gastric emptying, lipolysis, mixed triglyceride breath test, optimization, pancreatic disease, pancreatic function. Introduction At present, clinicians almost exclusively use the fecal elastase-1 test for measurement of pancreatic exocrine function, although this test has limited sensitivity for mild-to-moderate pancreatic exocrine insufficiency, and despite its limited specificity in patients with diarrhea.
Materials and methods Participants We identified and retrospectively analyzed data from consecutive patients whom underwent a 13 C-MTGT at our institution for clinical reasons, between January and February Ethics The study protocol for evaluation of pancreatic exocrine function in healthy volunteers was approved by the local ethics committee Ethik-Kommission der Ärztekammer Hamburg, reference number and all subjects gave written informed consent prior to any study-related procedures.
Gastric emptying breath test A subset of patients additionally underwent a 13 C-OAT for measurement of gastric emptying of solids.
Results Of the patients investigated, 19 had incomplete data, so they were excluded from further analysis Figure 1. Open in a separate window. Conflict of interest None declared.
Die diagnostische Validitat nichtinvasiver Pankreasfunktionstests: Z Gastroenterol ; Synopsis of recent guidelines on pancreatic exocrine insufficiency. Unit Europ Gastroenterol J ; 1: A modified 13C-mixed triglyceride breath test detects moderate pancreatic exocrine insufficiency.
Mixed triglyceride breath test: A noninvasive test of pancreatic lipase activity in the duodenum. Comparative clinical evaluation of the 13C-mixed triglyceride breath test as an indirect pancreatic function test. Scand J Gastroenterol ; Clin Gastroenterol Hepatol ; 5: Pancreatic physiology and secretory testing.
Definition, atiologie, diagnostik, konservative, interventionell endoskopische und operative therapie der chronischen pankreatitis. Optimized conditions for determining activity concentration of alpha-amylase in serum, with 1,4-alpha-Dnitrophenylmaltoheptaoside as substrate. Clin Chem ; Evaluation of a new alpha-amylase assay using 4. J Clin Chem Clin Biochem ; Determination of serum lipase with automated systems. A modified spectrophotometric determination of trypsin, chymotrypsin and thrombin.
Can J Biochem ; Isotope selective non-dispersive infrared spectrometry in comparison with isotope ratio mass spectrometry in volunteers and patients with chronic pancreatitis. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Eur J Gastroenterol Hepatol ; Influence of clinical parameters on the results of C-octanoic acid breath tests: Examination of different mathematical models in a large patient cohort. Neurogastroenterol Motil ; 21 —e The 13 C-mixed triglyceride breath test in healthy adults: Determinants of the 13 CO 2 response.
Erste Kur (Test E mg) : Roids & Prohormone
K. Huhnstock, W. Kutscha Störung Grundum- Radiojod- PBJ T3-Test weitere Teste SatZ aufnahme Diffuser, tox. Hypothyreose N N N N TSH-Test negativ Sek. Serumcholesterin Normalwerte: – mg/ ml A. Relativ erhöht. Expositionstestungen mit Acetylsalicylsäure AÖ, Angioödem(e); UR, Urtikae; RH, Rhinitis; LN, Luftnot; AB, Asthma bronchiale; crUR, w AÖ, UR, RH, LN (30 min) pos ja - neg 56 AÖ ( mg/1 h) 54 m RH, Erytheme ( 30 min). Obwohl ich mich entschieden habe um test c e7d aber das Injektionsintervall bei Testo E oder C sollte max. e5d liegen und nicht e7d:w kann mich nur anschließen. lieber mg und eine längere spanne!.