Assessment of pancreatic exocrine insufficiency and pancreatic enzyme dose-response using the 13 C-Mixed triglyceride breath test

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Abstract
Faecal elastase-1 testing is the most commonly used method for diagnosing pancreatic exocrine insufficiency (PEI), but has poor diagnostic precision and cannot guide titration of pancreatic enzyme replacement therapy (PERT). An alternative is 13C-mixed triglyceride breath test. We investigated concordance between breath test and faecal elastase-1, and response to bicarbonate-buffered enzymes. In this prospective study, adults with faecal elastase 13CO2 exhalation (substudy II). Baseline tests where performed in 25 participants. Thirteen participants had normal breath test, 11 agreed to pause PERT, but only five participants did not reinitiate treatment (substudy I). 12 participants were included in substudy II (mean age 65, all males). All had significant breath test improvements on lowest enzyme dose (24,000 IU) versus baseline (mean difference 21.5%, p < 0.001), yet higher enzyme doses did not improve results significantly. About half of participants previously categorised with PEI had normal 13C-mixed triglyceride breath test, questioning diagnosis. Most participants demonstrated normal breath test with lowest enzyme dose during standardised test meal. However, this finding may not generalise to habitual meals.
Funding Information
  • Digestive Care, Inc
  • Digestive Care Inc.

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