Assessment of the gastric emptying velocity by the 13C-octanoate breath test: deconvolution versus a Wagner-Nelson analysis

European guideline on indications, performance and clinical impact of 13 C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC

INTRODUCTION

13 C-breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers.

METHODS

This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of 13 C-breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed.

RESULTS

The guideline gives an overview over general methodology of 13 C-breath testing and provides recommendations for the use of 13 C-breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of 13 C-breath testing are summarized briefly. The recommendations specifically detail when and how individual 13 C-breath tests should be performed including examples for well-established test protocols, patient preparation, and reporting of test results.

CONCLUSION

This clinical practice guideline should improve pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of 13 C-breath tests.

Measurement of gastric emptying time of solids in healthy subjects using scintigraphic method: a revised technique

The gastric emptying half time (GET) of solid food in 24 healthy volunteers (11M/13F) was evaluated using a revised technique and a gamma camera scan. Within 20 min and after 8 h of fasting, each volunteer ate two pieces of toast with a two-egg-omelette that was mixed with 18.5 MBq (99m)Tc-labelled phytate. The raw data were analysed in the MATLAB program to establish the gastric intestine tract (GI tract) biokinetic model. The GI tract model defines the metabolic mechanism with reference to five compartments, which are stomach, body fluid, small intestine (SI), upper large intestine and lower large intestine, according to the ICRP-30 report. The model was expressed using four simultaneous time-dependent differential equations. The gastric emptying half-time and T(1/2eff)(SI) of males were 62.6±15.4 and 149.8±204.1 min, respectively, and those of females were 98.8±16.3 and 131.6±38.4 min.

Will the 13C-octanoic acid breath test ever replace scintigraphy as the gold standard to assess gastric emptying?

The applicability of the 13C-octanoic acid breath test for the assessment of gastric emptying is discussed. In the current issue of this journal, Keller and her colleagues described the application of different mathematical models for analysis of the 13C-octanoic acid test in a very large patient population.