Simultaneous assessments of exocrine pancreatic function by cholesteryl-[14C]octanoate breath test and measurement of plasma p-aminobenzoic acid

Abstract Two noninvasive tests for assessing pancreatic exocrine function, the cholesteryl-[14C]octanoate breath test and the HPLCN-benzoyl-tyrosyl-p-aminobenzoic acid/p-aminosalicylic acid (NBT-PABA/PAS) test, were simultaneously performed in nine patients with pancreatic exocrine insufficiency due to chronic pancreatitis and in nine healthy volunteers. 14CO2 output in breath and plasma PABA concentration rose slowly in patients but increased rapidly in healthy subjects. The measurement time giving the best discrimination between both groups was 120 min for the cholesteryl-[14C]octanoate breath test and 90 min for the plasma PABA test. At these points, both single-sample tests had essentially identical diagnostic sensitivity. The diagnostic sensitivities of the two single-sample tests were equal to that of the cumulative 6-h urinary PABA recovery and the cumulative 6-h urinary PABA/PAS ratio. We conclude that, for both the cholesteryl-[14C]octanoate breath test and the plasma PABA test, a single test sample is sufficient for rapid detection of impaired exocrine pancreatic function.

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Bentiromide as a test of exocrine pancreatic function in adult patients with pancreatic exocrine insufficiency

Gastroenterology ◽

10.1016/0016-5085(83)90008-2 ◽

1983 ◽

Vol 85 (3) ◽

pp. 565-569 ◽

Cited By ~ 35

Author(s):

Phillip P. Toskes

Keyword(s):

Exocrine Pancreatic Function ◽

Pancreatic Function ◽

Adult Patients ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Pancreatic Exocrine

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13C labelled cholesteryl octanoate breath test for assessing pancreatic exocrine insufficiency

Gut ◽

10.1136/gut.42.1.81 ◽

1998 ◽

Vol 42 (1) ◽

pp. 81-87 ◽

Cited By ~ 34

Author(s):

M Ventrucci ◽

A Cipolla ◽

G M Ubalducci ◽

A Roda ◽

E Roda

Keyword(s):

Breath Test ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Pancreatic Disease ◽

Exocrine Pancreatic Function ◽

Significant Rise ◽

Exocrine Pancreatic Insufficiency ◽

Pancreatic Function ◽

Healthy Controls ◽

Exocrine Insufficiency

Background—A non-invasive test for assessment of fat digestion has been developed based on the intraluminal hydrolysis of cholesteryl-[1-13C]octanoate by pancreatic esterase.Aims—To determine the diagnostic performance of this breath test in the assessment of exocrine pancreatic function.Methods—The test was performed in 20 healthy controls, 22 patients with chronic pancreatic disease (CPD), four with biliopancreatic diversion (BPD), and 32 with non-pancreatic digestive diseases (NPD); results were compared with those of other tubeless tests (faecal chymotrypsin and fluorescein dilaurate test).Results—Hourly recoveries of13CO2 were significantly lower in CPD when compared with healthy controls or NPD. In patients with CPD with mild to moderate insufficiency, the curve of 13CO2recovery was similar to that of healthy controls, while in those with severe insufficiency it was flat. In three patients with CPD with severe steatorrhoea, a repeat test after pancreatic enzyme supplementation showed a significant rise in13CO2 recovery. The four BPD patients had low and delayed 13CO2 recovery. Only eight of the 32 patients with NPD had abnormal breath test results. There was a significant correlation between the results of the breath test and those of faecal chymotrypsin, the fluorescein dilaurate test, and faecal fat measurements. For the diagnosis of pancreatic disease using the three hour cumulative 13CO2 recovery test, the sensitivity was 68.2% and specificity 75.0%; values were similar to those of the other two tubeless pancreatic function tests. In seven healthy controls, nine patients with CPD, and nine with NPD a second breath test was performed using Na-[1-13C]octanoate and a pancreatic function index was calculated as the ratio of13C recovery obtained in the two tests: at three hours this index was abnormal in eight patients with CPD and in three with NPD.Conclusion—The cholesteryl-[1-13C]octanoate breath test can be useful for the diagnosis of fat malabsorption and exocrine pancreatic insufficiency.

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Exocrine pancreatic function as determined in a same-day test with use of bentiromide and p-aminosalicylic acid.

Clinical Chemistry ◽

10.1093/clinchem/32.6.1010 ◽

1986 ◽

Vol 32 (6) ◽

pp. 1010-1012 ◽

Cited By ~ 12

Author(s):

J D Berg ◽

I M Chesner ◽

R A Allen-Narker ◽

B M Buckley ◽

N Lawson

Keyword(s):

High Performance Liquid Chromatography ◽

Liquid Chromatography ◽

High Performance ◽

Exocrine Pancreatic Function ◽

Pancreatic Function ◽

Aminobenzoic Acid ◽

Aminosalicylic Acid ◽

New Approach ◽

Pharmacokinetic Behavior

Abstract We describe a new approach to the bentiromide test of exocrine pancreatic function, p-Aminosalicylic acid (PAS), a compound closely related to the bentiromide fragment p-aminobenzoic acid (PABA), is used as a marker of the pharmacokinetic behavior of PABA to derive a PABA excretion index. This index is identical to that derived with [14C]-PABA. Concentrations of both PABA and PAS are measured in urine by "high-performance" liquid chromatography, which avoids the drug interferences encountered with established assays of PABA. We discuss the practical and diagnostic advantages of this new approach to the bentiromide test.

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Combined Single Day 14C-Triolein Breath Test and Paba Test in the Diagnosis of Malabsorption

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456329002700110 ◽

1990 ◽

Vol 27 (1) ◽

pp. 50-55 ◽

Cited By ~ 2

Author(s):

S C Fleming ◽

M S Kapembwa ◽

G E Griffin

Keyword(s):

Breath Test ◽

Gastrointestinal Disease ◽

Pancreatic Insufficiency ◽

Pancreatic Disease ◽

Exocrine Pancreatic Function ◽

Exocrine Pancreatic Insufficiency ◽

Pancreatic Function ◽

Fat Absorption ◽

Aminosalicylic Acid ◽

Function Combination

The 14C-triolein breath test, a recognised index of fat absorption, and the p-aminobenzoic acid (PABA) test, a ‘tubeless’ test of exocrine pancreatic function, have both been widely used in the diagnosis of malabsorption and exocrine pancreatic insufficiency. This study evaluates the potential of a combination of both tests in the investigation of fat absorption and exocrine pancreatic function. Combination of the tests has become technically feasible because of the introduction of high pressure liquid chromatography as the preferred method of analysis for PABA, and use of p-aminosalicylic acid (PAS) as the marker for PABA absorption and metabolism We studied 25 healthy subjects, 11 patients with exocrine pancreatic disease and 12 patients with gastrointestinal disease. The combined test identified subjects with reduced fat absorption and distinguished subjects with exocrine pancreatic insufficiency from those with an intestinal cause of fat malabsorption. The test could be completed in 7 h and had high patient acceptibility. These findings suggest that the combined 14C-triolein breath test and PABA test can be used as a non-invasive, 1-day investigation of fat absorption and exocrine pancreatic function.

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960 13C-Mixed Triglyceride Breath Test versus Fecal Elastase for the Diagnosis of Pancreatic Exocrine Insufficiency

Gastroenterology ◽

10.1016/s0016-5085(16)30722-3 ◽

2016 ◽

Vol 150 (4) ◽

pp. S191

Author(s):

Enrique de-Madaria ◽

Rahma Amrani ◽

Celia Trigo ◽

Víctor Luis González-Sánchez

Keyword(s):

Breath Test ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Fecal Elastase ◽

Pancreatic Exocrine

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Study on the exocrine pancreatic function by the oral administration of N-benzoyl-L-tyrosyl-para-aminobenzoic acid

Gastroenterologia Japonica ◽

10.1007/bf02776797 ◽

1977 ◽

Vol 12 (4) ◽

pp. 289-292 ◽

Cited By ~ 5

Author(s):

Kazuyuki Kato ◽

Shigeru Izumiyama ◽

Muneki Sakakura ◽

Akio Hirayama ◽

Kaneo Ishii

Keyword(s):

Oral Administration ◽

Exocrine Pancreatic Function ◽

Pancreatic Function ◽

Aminobenzoic Acid

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13 C-Di-Peptide Breath Test to Assess Exocrine Pancreatic Function in Chronic Pancreatitis: A Novel Non-Invasive Method

Gastroenterology ◽

10.1016/s0016-5085(11)62258-0 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-545

Author(s):

Bimaljit S. Sandhu ◽

Rajesh Gupta ◽

D. Nageshwar Reddy ◽

Ravi Vachhani ◽

Doumit BouHaidar ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Breath Test ◽

Exocrine Pancreatic Function ◽

Pancreatic Function ◽

Non Invasive ◽

Invasive Method

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Serum Immunoreactive Pancreatic Lipase and Cationic Trypsinogen for the Assessment of Exocrine Pancreatic Function in Older Patients With Cystic Fibrosis

PEDIATRICS ◽

10.1542/peds.77.3.301 ◽

1986 ◽

Vol 77 (3) ◽

pp. 301-306

Author(s):

Geoffrey Cleghorn ◽

Lynne Benjamin ◽

Mary Corey ◽

Gordon Forstner ◽

Francesco Dati ◽

...

Keyword(s):

Cystic Fibrosis ◽

Pancreatic Lipase ◽

Elevated Serum ◽

Serum Levels ◽

Exocrine Pancreatic Function ◽

Pancreatic Function ◽

Exocrine Function ◽

Serum Lipase ◽

Significant Difference ◽

Cationic Trypsinogen

Indirect and qualitative tests of pancreatic function are commonly used to screen patients with cystic fibrosis for pancreatic insufficiency. In an attempt to develop a more quantitative assessment, we compared the usefulness of measuring serum pancreatic lipase using a newly developed enzyme-linked immunosorbent immunoassay with that of cationic trypsinogen using a radioimmunoassay in the assessment of exocrine pancreatic function in patients with cystic fibrosis. Previously, we have shown neither lipase nor trypsinogen to be of use in assessing pancreatic function prior to 5 years of age because the majority of patients with cystic fibrosis in early infancy have elevated serum levels regardless of pancreatic function. Therefore, we studied 77 patients with cystic fibrosis older than 5 years of age, 41 with steatorrhea and 36 without steatorrhea. In addition, 28 of 77 patients consented to undergo a quantitative pancreatic stimulation test. There was a significant difference between the steatorrheic and nonsteatorrheic patients with the steatorrheic group having lower lipase and trypsinogen values than the nonsteatorrheic group (P <.001). Sensitivities and specificities in detecting steatorrhea were 95% and 86%, respectively, for lipase and 93% and 92%, respectively, for trypsinogen. No correlations were found between the serum levels of lipase and trypsinogen and their respective duodenal concentrations because of abnormally high serum levels of both enzymes found in some nonsteatorrheic patients. We conclude from this study that both serum lipase and trypsinogen levels accurately detect steatorrhea in patients with cystic fibrosis who are older than 5 years but are imprecise indicators of specific pancreatic exocrine function above the level needed for normal fat absorption.

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