Sensitivity and specificity of an abbreviated 13C-mixed triglyceride breath test for measurement of pancreatic exocrine function

Background: A modified C-13-mixed triglyceride breath test (C-13 -MTGT) detects moderate pancreatic exocrine insufficiency noninvasively and reliably, but it requires prolonged breath sampling (6 hours (hr)). Objective: We aimed to investigate whether C-13 -MTGT can be abbreviated, to optimize clinical usability. Methods: We analyzed the C-13 -MTGT of 200 consecutive patients, retrospectively. Cumulative 1-5 hr C-13-exhalation values were compared with the standard parameter (6-hr cumulative C-13-exhalation). 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. Moreover, we evaluated the influence of gastric emptying (GE), using a C-13-octanoic acid breath test in a subset (N = 117). Results: The 1-5 hr cumulative C-13-exhalation tests correlated highly and significantly with the standard parameter (p< 0.0001). Sensitivity for detection of impaired lipolysis was high (>= 77%), but the specificity was low (>= 38%) for the early measurements. Both parameters were high after 4 hrs (88% and 94%, respectively) and 5 hrs (98% and 91%, respectively). Multivariate linear correlation analysis confirmed that GE strongly influenced early postprandial C-13-exhalation during the C-13-MTGT. Conclusion: Shortening of the C-13 -MTGT from 6 to 4 hrs of duration was associated with similar diagnostic accuracy, yet increased clinical usability. The influence of GE on early postprandial results of the C-13-MTGT precluded further abbreviation of the test.