SUMMARY The absorption of 14C triolein in a standard fat meal was measured in 60 controls and 66 patients with gastrointestinal disorders by 14CO2 breath sampling. A reference range based upon cumulative eight hour values of the controls was independent of height, weight, and sex. The range was of log normal distribution and declined with age (p<005). Acceptable 'within-day' and 'between-day' reproducibility was found. All patients tested with untreated coeliac disease, pancreatic insufficiency and most with symptomatic small intestinal Crohn's disease had subnormal values. Twenty per cent of those with irritable bowel syndrome had subnormal values. Patients with ulcerative colitis were all normal. The reagents used and the breath samples after collection were stable. In our experience the 14C triolein test is simple, inexpensive, and helpful in the detection of diseases associated with fat malabsorption. It is of value in monitoring the response to treatment of individual patients with coeliac disease.Gastrointestinal symptoms such as diarrhoea, change in stools, and weight loss are among the most common complaints presenting to the general practitioner. When the patients eventually reach the physician with an interest in gastroenterology, initial investigations having been unhelpful, the question of fat malabsorption is raised. The estimation of faecal fat is traditionally regarded as the 'gold standard' for this purpose. Thorsgaard-Pederson and Halgreen have shown that, unless a controlled intake-excretion study is carried out, estimation of faecal fat is only a qualitative test. The diagnostic efficiency is only 80%1 and the test is widely regarded as time consuming and unpleasant for the laboratory. 'The inconvenience, the uncontrollable sources of error and the difficulties in obtaining quantitative information make measurement of faecal fat and weight inexpedient as a clinical test'.' For these reasons. we helieve faecal fat estimations do not meet the requirements of a district general hospital as a routine test of malabsorption. An alternative test less dependent on patient compliance is certainly needed.The factors to be evaluated in assessing the
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