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13C-Mixed Triglyceride Breath Test and Fecal Elastase as an Indirect Pancreatic Function Test in Cystic Fibrosis

Dorothea Stark Kent1, Thomas Remer2, Caron Blumenthal1,3

  • 1James Fairfax Institute of Paediatric Nutrition, University of Sydney, Sydney, Australia.

Journal of Pediatric Gastroenterology and Nutrition
|February 13, 2018
PubMed

Insights

New tests for pancreatic function in infants with cystic fibrosis (CF) show promise for detecting insufficiency but fail to reliably identify pancreatic sufficiency. The C-mixed triglyceride breath test and fecal elastase-1 tests are not yet suitable alternatives to the fecal fat test.

Area of Science:

  • Pediatrics
  • Gastroenterology
  • Genetics

Background:

  • The 72-hour fecal fat excretion test is the standard for assessing pancreatic function in infants with cystic fibrosis (CF).
  • This traditional method is facing obsolescence, necessitating evaluation of alternative diagnostic tools.
  • Accurate pancreatic function assessment is crucial for determining the pancreatic phenotype in CF infants.

Purpose of the Study:

  • To evaluate the clinical utility of the C-mixed triglyceride (MTG) breath test and fecal elastase-1 (FE1) as indirect pancreatic function tests in infants with CF.
  • To compare the diagnostic accuracy of these novel tests against the established 72-hour fecal fat assessment.

Main Methods:

  • A comparative study involving 24 infants with CF.
  • The C-MTG breath test and two types of FE1 tests (monoclonal and polyclonal) were performed.
  • Tests were conducted after withholding oral pancreatic enzyme replacement therapy (PERT).

Main Results:

  • Both C-MTG breath test and FE1 tests demonstrated high sensitivity (82%-100%) in identifying pancreatic insufficiency in CF patients.
  • However, sensitivity rates for detecting pancreatic-sufficient CF patients were unacceptably low for C-MTG (31%-38%) and FE1 tests (45%-54%).

Conclusions:

  • The C-MTG breath test and FE1 tests are not yet reliable alternatives to the fecal fat balance test for evaluating pancreatic function in infants with CF within their first year of life.
  • Further refinement and validation are needed for these noninvasive tests to accurately assess both pancreatic insufficiency and sufficiency in this population.
Abstract

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