6
13
C-Breath tests for assessment of gastrointestinal disorders and liver function
PD Dr. med. Oliver Götze, Zürich
Infection
• Helicobacter pylori
• Bacterial overgrowth
in small intestine
Liver function
• Cytochrome demethylation
and decarboxylation
• Mitochondrial oxidation function
Pancreatic function
• Total amylase activity
• Exocrine lipase insufficiency
Motility
• Gastric emptying of liquids
• Gastric emptying of solid
test meals
Other metabolic functions
• Lactose malabsorption = lactose deficiency
• Dihydropyrimidine dehydrogenase availability
Total Energy Turnover
The
13
C breath test is characterised by its applicability in a wide range of diagnostic situations
fondue followed by Kirsch schnapps.
The fondue was labelled with
13
C so-
dium-octanoate and randomly con-
sumed with either 300ml white wine
or black tea followed by either a shot
(20ml) of schnapps (40%) or water.
The results demonstrated that gas-
tric emptying after consumption of
a Swiss fondue followed by high lev-
els of alcohol was slower than with
low levels, and that appetite was also
suppressed. Dyspeptic symptoms,
however, were not experienced.
Quantitative liver function testing
An indication for the
13
C breath test
with methacetine is quantitative
testing of liver function. The
13
C
methacetine breath test measures
microsomal O-demethylation where
the cleaved methyl groups are oxi-
dised to formic acid and then finally
to carbon dioxide and exhaled.
These types of
13
C breath tests per-
mit non-invasive quantification of
impaired liver function in patients
with liver fibrosis, and also a risk as-
sessment of any future decompen-
sation resulting from a hepactec-
tomy, or transplant function after a
liver transplant. Further indications
include the diagnosis and characteri-
sation of certain liver disorders as
well as pharmacological response
and side effects of therapy.
Reference:
(1) Heinrich H et al., BMJ 2012; 341: c6731
The
13
C breath test is particularly
useful in cases involving gastric and
intestinal motility problems such as
gastroparesis in patients with diabe-
tes or functional dyspepsia, intestinal
pseudo-obstruction or overly rapid
gastric emptying e.g. in patients with
dumping syndrome. Other gastric
emptying problems associated with
functional gastrointestinal disorders
and which manifest with functional
dyspepsia can be diagnosed with the
breath test.
In addition to its applicability in a rou-
tine clinical setting, the
13
C breath
test is also frequently applied in a re-
search setting, such as for the testing
of prokinetic pharmaceuticals or the
assessment of physiological effects
of digestive hormones (e.g. GLP-1)
on gastrointestinal motor function.
Other popular questions can be read-
ily and non-invasively answered us-
ing the breath test. In a recently pub-
lished study with 20 test persons,
the effect of wine and black tea on
gastric emptying and other gastroin-
testinal symptoms was analysed af-
ter they had enjoyed a Swiss cheese
1,2,3,4,5 7,8