[13C]Octanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients : validation and relationship to gastric symptoms and cardiovascular autonomic function

Since there is a need for a widely applicable non-invasive test to assess gastric emptying in diabetic patients, we evaluated the sensitivity, specificity, and reproducibility of the [13C]octanoic acid breath test as compared with scintigraphy. Moreover, we examined the relationship between the brea...

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Bibliographic Details
Published in:Diabetologia 1996-07, Vol.39 (7), p.823-830
Main Authors: ZIEGLER, D, SCHADEWALDT, P, MIRZA, A. P, PIOLOT, R, SCHOMMARTZ, B, REINHARDT, M, VOSBERG, H, BRÖSICKE, H, GRIES, F. A
Format: Article
Language:English
Subjects:
Adult
Antihypertensive Agents - analysis
Biological and medical sciences
Breath Tests - methods
Caprylates - analysis
Carbon Isotopes
Diabetes Mellitus - physiopathology
Female
Functional investigation of the digestive system
Gastric Emptying
Gastroparesis - diagnosis
Gastroparesis - physiopathology
Humans
Investigative techniques, diagnostic techniques (general aspects)
Linear Models
Male
Medical sciences
Middle Aged
Patient Compliance
Patient Selection
Radionuclide Imaging
Reproducibility of Results
Sensitivity and Specificity
Stomach - diagnostic imaging
Stomach - physiopathology
Time Factors
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Summary:Since there is a need for a widely applicable non-invasive test to assess gastric emptying in diabetic patients, we evaluated the sensitivity, specificity, and reproducibility of the [13C]octanoic acid breath test as compared with scintigraphy. Moreover, we examined the relationship between the breath test indices and gastric symptoms, cardiovascular autonomic function, and metabolic parameters. Forty healthy control subjects and 34 diabetic patients were studied. Three indices of gastric emptying, assessed by the breath test, were computed: half-emptying time (t1/2breath), gastric emptying coefficient (GEC), and lag phase. Furthermore, the half-emptying time, measured by scintigraphy (t1/2scint), was calculated and gastric symptoms and cardiovascular autonomic neuropathy (CAN) were scored. The coefficients of variation of day-to-day reproducibility in 10 healthy subjects were 29.6% for t1/2breath, 7.4% for GEC, and 46.5% for lag phase. An abnormal delay for t1/2scint (> 100 min) or t1/2breath (> 200 min) was noted in 12 patients. Based on the results for t1/2scint, the sensitivity of t1/2breath and GEC was 75% and the specificity was 86%. Both t1/2breath (rs = 0.523; p < 0.05) and GEC (r2 = -0.594; p < 0.05) were significantly associated with the gastric symptom score. A significant relationship to the CAN score was demonstrated for t1/2breath (rs = 0.448; p < 0.05), GEC (rs = -0.467; p < 0.05), and t1/2scint (rs = 0.602; p < 0.05). There were no significant associations of the breath test indices with the blood glucose levels during the test, HbA1c, age, and duration of diabetes. In patients with abnormal t1/2scint (n = 12) not only was t1/2breath significantly prolonged and GEC reduced, but also the scores of CAN and gastric symptoms were significantly increased as compared with those who had a normal t1/2scint (n = 22). We conclude that the [13C]octanoic acid breath test represents a suitable measure of delayed gastric emptying in diabetic patients which is associated with the severity of gastric symptoms and CAN but not affected by the blood glucose level.
ISSN:0012-186X
1432-0428
DOI:10.1007/s001250050516