¹³C‐gastric emptying breath tests: Clinical use in adults and children

Abstract

Since their introduction into clinical practice in the 1970 s, 1 stable isotope 13 C-breath tests ( 13 C-BT) have gained considerable importance and have been recommended for investigation of a variety of gastrointestinal and liver functions including gastric emptying (GE) measurements and for diagnosis of Helicobacter pylori. This is due to the fact that they are not only reliable, but also non-invasive, relatively simple, and safe diagnostic tools. 13 C is a stable, nonradioactive carbon isotope with a natural abundance of about 1% of carbon isotopes. 13 C-enrichment of marker substances does not affect their tolerability and conveys no discernible risk of toxicity.Depending on pharmacological properties of the marker substance itself, most clinically established 13 C-BT can also be performed in young children and pregnant women. 2 This also holds true for 13 C-gastric emptying breath tests ( 13 C-GEBT) using 13 C-octanoic acid, 13 C-Spirulina platensis, or 13 C-acetate as marker substances. However, 13 C-BT are indirect tests that involve several metabolic processes before 13 C-exhalation is achieved. Thus, 13 C-exhalation from these marker substances depends not only on GE, but also on absorption of the marker substance and/or its metabolites, further metabolism leading to production of 13 CO 2 , its transport to the lung and pulmonary excretion, and distribution to other body compartments. 3 Obviously, not only GE but also subsequent metabolization can be influenced by several factors including demographic parameters, fasting or fed state, composition and size of a test meal, physical activity, concurrent diseases, and drug intake. [4][5][6][7][8][9][10][11][12][13][14] The resulting need for strict standardization of 13 C-BT has prompted the development of a European consensus-based

Nausea is the only symptom associated with delayed gastric emptying in pediatric functional dyspepsia patients

“…After correlation for age, showed no influence of gender, weight, height, body mass index (BMI), and body surface area on the T ½. 1,3,20 Cut of values are described by Keller et al 21 …”

Meal Effects on Gastric Bioelectrical Activity Utilizing Body Surface Gastric Mapping in Healthy Subjects

“…These included an oatmeal energy bar with 250ml of water (Clif Bar; see above), a pancake with 180 ml water (11.2 g fat, 31.7 g carbohydrate, 8.4 g protein) 22 , and an egg with two slices of white toast and 180 ml of water (9.4 g fat, 34 g carbohydrate, 11.8 g protein) 23 . The latter two meals have also been applied as part of the routine gastric emptying breath test 24 .…”

“…A total of 238 study participants (59.2% female, median age 29 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) participants received an energy bar along with water, while 65 participants received an egg meal, and 18 participants received a pancake with water. The percentage of 100% meal completion was significantly higher with a smaller meal (97.7% vs 89.1%, p<0.01).…”

Prevalence and disease burden of gastroparesis in Asia

“…Gastric ultrasound with high nutrient liquid and magnetic resonance imaging have shown accurate results for gastric emptying; however, their use has been limited to research because of practical reasons. [28][29][30] Two new diagnostic techniques showing promising potential are the 13 C gastric emptying breath test (GEBT) and the wireless motility capsule (WMC; see Table 2 for comparison). In 2015, GEBT was approved by the Food and Drug Administration as a reliable alternative for scintigraphy for the diagnosis of gastroparesis.…”

“…A 4-h scintigraphy is recognized as the gold standard for diagnosis and is recommended in the European consensus. 10 However, this practice has not been widely adopted, and many centers in the United States only perform the test over 1-2 h. 29 European nations lack one widely recognized diagnostic protocol, which is both reliable and could be chosen as the standardized procedure. 36 The type of test meal used also requires standardization.…”