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The lipase breath test to study exocrine pancreatic insufficiency and the effects of enzyme supplementation in cystic fibrosis patients
Abstracts
/Netherlands
Journal
of Medicine
47 (1995)
A5
Al -A42
[ ]=SD Baseline patient characteristics
Verum
Number of patients Men/women Mean age (yr) Mean weight loss (kg) Tumor size (cm) (abdominal ultrasound) Presence of liver metastases Presence of lung metastases Fat absorption coefficient
11 4/l 73 [ll] - 9.9 is.71 3.5 Il.31 0 0
Placebo 10 4/6 79 [91 - 12.9 19.11 3.9 [LO] 1 0
70 [28]
72 [24]
Verum 0.7 [2.5] 12 [25]
Placebo
p-value
- 2.2 [2.7] - 8 [25] -
0.024 0.126 N.S.
201.5 [449] 791 [256] 305 [71] 911 (2391
1594 [427] 634 [224] 220 [57] 741 [228]
0.040 0.151 0.007 0.113
[ ]=SD
Results
Study parameters Mean change in body weight (kg) Mean change in fat absorption coefficient Change in steatorrhoea-associated complaints (e.g., frequency, amount, consistency, smell) Mean daily caloric intake (kcal) Mean daily fat intake (kcal) Mean daily protein intake (kcal) Mean daily carbohydrate intake (kcal)
Conclusion: Enteric-coated pancreatin microsphere treatment in patients with NMT-PHR reduced weight loss. This was mainly due to a higher caloric intake during enzyme treatment. Patients seemed to prefer control of their body weight rather than control of steatorrhea and associated complaints. [This study was financially supported by Knoll B.V., Amsterdam, Netherlands.]
Tbe lipase breath test to study exocrine pancreatic insuffL ciency and the effects of enzyme supplementation in cystic fibrosis patients. G.R. Swart, I. Leeuwenburgh, D. Kosmeyer, T. Rietveld, J.L.D. Wattimena, J.W.O. van den-Berg. Department of Internal Medicine terdam, Netherlands.
II,
University
Hospital
Dijkzigt,
Rot-
The lipase breath test measures the postprandial intraduodenal lipase activity. When a labelled triglyceride (1,3-distearoyl, 2[ ‘3C-carboxyljoctanoyl glycerol) is supplied with a test meal, t3C-octanote, released by the action of lipase, will be absorbed and oxidised, producing 13C0,. Since lipase activity is the rate-limiting step in this process, it can be quantitated by determining total exhaled r3C0,. We performed this test to detect the presence and degree of pancreatic insufficiency and to study the effects of enzyme supplementation, and the additional effects of gastric acid reduction, in a group of 11 young adult cystic fibrosis (CF) patients, mean age 26 (range 20-38) years. Exocrine pancreatic insufficiency had been documented before by fat balance measurements. After an overnight fast, the patients collected 2 baseline breath samples by exhaling into plain vacutainer tubes through a drinking straw. The patients took a breakfast consisting of 2 sandwiches with cheese and marmalade, with 10 g of butter in
which 250 mg of r3C-labelled triglyceride was mixed. Following the meal breath samples were taken every 30 min for a period of 5 h. Breath CO, was measured for r3C-isotope content (VG SIRAIRMS) and cumulative “CO2 excretion (% of dose) was calculated using a presumed Vco, of 10.8 mmol/kg. h, corrected to 120% to compensate for presumed hypermetabolism. Mean fat loss was 12.8 g/d (range 6.7-21.8 g/d) in the group of 11 patients. A mean 5-h cumulative ‘“COz recovery of 11.5% (range 0.6-32%) was found in the untreated situation and of 14.8% (range 6.0-21%) on enzyme supplementation [mean dose 15X LO3 (range 10x103-20X 10”) lipase units]. With enzymes (20X lo3 U) and omeprazole (20 mg) (n = 3) a slight further improvement to a mean excretion of 22.2% (range 19.4-26.3%) was found. In a control group of 12 healthy volunteers, a cumulative mean excretion of 35(5)% was established. Strict adherence to the protocol, i.e. performing the study in the overnight fasting state, was found to be essential since nocturnal tube feeding disturbed the test. Conclusion: The lipase breath test is a suitable technique to detect exocrine pancreatic insufficiency in CF patients. When used to monitor treatment, it indicates that improvement - but not full correction - of duodenal lipase activity is obtained. Gastric acid inhibition will give some improvement in the efficiency of enzyme supplementation. The palliative effect of meta-iodobenzyigaanidine &EIBG) in the carcinoid syndrome. B.G. Taal r, C.A. Hoefnagel ‘, R. Valdes Olmos 2, H. Boot ‘. Department of I Castro-mterology and ’ Nuclear Medicine, Amsterdam, Netherlands.
Netherlands
Cancer
Institute
/ AvL.
‘311-Meta-iodobenzylguanidine (MIBG), an analogue of a biogene amine precursor, is taken up by chromaffin cells and
/Netherlands
Journal
of Medicine
47 (1995)
A5
Al -A42
[ ]=SD Baseline patient characteristics
Verum
Number of patients Men/women Mean age (yr) Mean weight loss (kg) Tumor size (cm) (abdominal ultrasound) Presence of liver metastases Presence of lung metastases Fat absorption coefficient
11 4/l 73 [ll] - 9.9 is.71 3.5 Il.31 0 0
Placebo 10 4/6 79 [91 - 12.9 19.11 3.9 [LO] 1 0
70 [28]
72 [24]
Verum 0.7 [2.5] 12 [25]
Placebo
p-value
- 2.2 [2.7] - 8 [25] -
0.024 0.126 N.S.
201.5 [449] 791 [256] 305 [71] 911 (2391
1594 [427] 634 [224] 220 [57] 741 [228]
0.040 0.151 0.007 0.113
[ ]=SD
Results
Study parameters Mean change in body weight (kg) Mean change in fat absorption coefficient Change in steatorrhoea-associated complaints (e.g., frequency, amount, consistency, smell) Mean daily caloric intake (kcal) Mean daily fat intake (kcal) Mean daily protein intake (kcal) Mean daily carbohydrate intake (kcal)
Conclusion: Enteric-coated pancreatin microsphere treatment in patients with NMT-PHR reduced weight loss. This was mainly due to a higher caloric intake during enzyme treatment. Patients seemed to prefer control of their body weight rather than control of steatorrhea and associated complaints. [This study was financially supported by Knoll B.V., Amsterdam, Netherlands.]
Tbe lipase breath test to study exocrine pancreatic insuffL ciency and the effects of enzyme supplementation in cystic fibrosis patients. G.R. Swart, I. Leeuwenburgh, D. Kosmeyer, T. Rietveld, J.L.D. Wattimena, J.W.O. van den-Berg. Department of Internal Medicine terdam, Netherlands.
II,
University
Hospital
Dijkzigt,
Rot-
The lipase breath test measures the postprandial intraduodenal lipase activity. When a labelled triglyceride (1,3-distearoyl, 2[ ‘3C-carboxyljoctanoyl glycerol) is supplied with a test meal, t3C-octanote, released by the action of lipase, will be absorbed and oxidised, producing 13C0,. Since lipase activity is the rate-limiting step in this process, it can be quantitated by determining total exhaled r3C0,. We performed this test to detect the presence and degree of pancreatic insufficiency and to study the effects of enzyme supplementation, and the additional effects of gastric acid reduction, in a group of 11 young adult cystic fibrosis (CF) patients, mean age 26 (range 20-38) years. Exocrine pancreatic insufficiency had been documented before by fat balance measurements. After an overnight fast, the patients collected 2 baseline breath samples by exhaling into plain vacutainer tubes through a drinking straw. The patients took a breakfast consisting of 2 sandwiches with cheese and marmalade, with 10 g of butter in
which 250 mg of r3C-labelled triglyceride was mixed. Following the meal breath samples were taken every 30 min for a period of 5 h. Breath CO, was measured for r3C-isotope content (VG SIRAIRMS) and cumulative “CO2 excretion (% of dose) was calculated using a presumed Vco, of 10.8 mmol/kg. h, corrected to 120% to compensate for presumed hypermetabolism. Mean fat loss was 12.8 g/d (range 6.7-21.8 g/d) in the group of 11 patients. A mean 5-h cumulative ‘“COz recovery of 11.5% (range 0.6-32%) was found in the untreated situation and of 14.8% (range 6.0-21%) on enzyme supplementation [mean dose 15X LO3 (range 10x103-20X 10”) lipase units]. With enzymes (20X lo3 U) and omeprazole (20 mg) (n = 3) a slight further improvement to a mean excretion of 22.2% (range 19.4-26.3%) was found. In a control group of 12 healthy volunteers, a cumulative mean excretion of 35(5)% was established. Strict adherence to the protocol, i.e. performing the study in the overnight fasting state, was found to be essential since nocturnal tube feeding disturbed the test. Conclusion: The lipase breath test is a suitable technique to detect exocrine pancreatic insufficiency in CF patients. When used to monitor treatment, it indicates that improvement - but not full correction - of duodenal lipase activity is obtained. Gastric acid inhibition will give some improvement in the efficiency of enzyme supplementation. The palliative effect of meta-iodobenzyigaanidine &EIBG) in the carcinoid syndrome. B.G. Taal r, C.A. Hoefnagel ‘, R. Valdes Olmos 2, H. Boot ‘. Department of I Castro-mterology and ’ Nuclear Medicine, Amsterdam, Netherlands.
Netherlands
Cancer
Institute
/ AvL.
‘311-Meta-iodobenzylguanidine (MIBG), an analogue of a biogene amine precursor, is taken up by chromaffin cells and