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Abbreviated 13C-mixed triglyceride breath test for detection of pancreatic exocrine insufficiency performs equally as standard 5-hour test in patients after gastrectomy performed for gastric cancer

Darko Siuka
Darko Siuka
, 
Kristina Kumer
Kristina Kumer
, 
Borut Stabuc
Borut Stabuc
, 
David Stubljar
David Stubljar
, 
David Drobne
David Drobne
 e 
Rado Jansa
Rado Jansa
   | 14 ago 2022
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Article Category: research article
Pubblicato online: 14 ago 2022
Pagine: 390 - 397
Ricevuto: 28 mar 2022
Accettato: 12 giu 2022
DOI: https://doi.org/10.2478/raon-2022-0034
© 2022 Darko Siuka, Kristina Kumer, Borut Stabuc, David Stubljar, David Drobne, Rado Jansa, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Receiver operating characteristic (ROC) curves for respective time points of breathing test for all subjects. NPV = negative predictive values; PPV = positive predictive values; Sens = sensitivity; Spec = specificity
Receiver operating characteristic (ROC) curves for respective time points of breathing test for all subjects. NPV = negative predictive values; PPV = positive predictive values; Sens = sensitivity; Spec = specificity

Differences between patient with positive and negative pancreatic exocrine insufficiency (PEI) determined by 13C-mixed triglyceride breath*

PEI
 p-value
Positive < 26.8 (n = 22) Negative > 26.8 (n = 43)
Sex
Male/Female 16/6 22/21 0.095
Age [years] 63.5 ± 12.8 57.2 ± 18.5 0.157
Weight [kg] 72.8 ± 15.8 65.5 ± 14.7 0.069
Height [m] 1.7 ± 0.1 1.7 ± 0.1 0.447
BMI 24.4 ± 4.0 22.5 ± 4.1 0.082
Smoking 0.181
No 17 (77.3%) 39 (90.7%)
< 15/day 3 (13.6%) (2.3%)
15/day 2 (9.1%) 3 (7.0%)
Coffee 0.107
No 9 (40.9%) 14 (32.6%)
1−2/day 12 (54.5%) 17 (39.5%)
> 2/day 1 (4.5%) 11 (25.6%)
Alcohol 0.527
No 14 (63.6%) 33 (76.7%)
< 2 units/day 7 (31.8%) 9 (20.9%)
> 2 units/day 1 (4.5%) 1 (2.3%)
Cholesterol 4.5 ± 0.8 4.4 ± 0.8 0.523
HDL_cholesterol 1.3 ± 0.4 1.5 ± 0.5 0.091
LDL_cholesterol 2.6 ± 0.8 2.5 ± 0.6 0.630
Triglycerides 1.6 ± 1.0 1.0 ± 0.6 0.011

Cut-off values for prediction of non-pancreatic exocrine insufficiency (non-PEI) within respective timepoints in all subjects

All patients
cut-off AUC 95% CI p-value Sensitivity Specificity PPV NPV
30 min 0.25 0.591 0.444−0.737 0.233 53.5% 68.2% 42.9% 76.7%
60 min 1.16 0.662 0.522−0.801 0.034 67.4% 54.5% 46.2% 74.4%
90 min 3.79 0.776 0.654−0.898 < 0.001 67.4% 81.8% 56.3% 87.9%
120 min 4.71 0.845 0.738−0.952 < 0.001 88.4% 72.7% 76.2% 86.4%
150 min 13.74 0.929 0.853−1.000 < 0.001 93.0% 90.9% 87.0% 95.2%
180 min 16.19 0.938 0.869−1.000 < 0.001 93.0% 90.9% 87.0% 95.2%
210 min 18.64 0.948 0.888−1.000 < 0.001 95.3% 90.9% 90.9% 95.3%
240 min 20.85 0.962 0.902−1.000 < 0.001 97.7% 90.9% 95.2% 95.5%
270 min 25.71 0.962 0.891−1.000 < 0.001 97.7% 95.5% 95.5% 97.7%
300 min 26.95 0.962 0.889−1.000 < 0.001 100% 95.5% 100% 97.7%

Basic characteristics of subjects enrolled in the study

All subjects N = 65 Healthy controls N = 20 Subtotal resection N = 23 Total resection N = 22 p-value
Sex M/F 38 (58.5%)/27 (41.5%) 7/13 14/9 17/5 0.020
Age [years] 59.3 ± 16.9 43.4 ± 13.4 62.7 ± 13.8 70.2 ± 11.4 < 0.001
Age group < 0.001
18−40 y 8 (12.3%) 7 (35.0%) 1 (4.3%) 0
41−65 y 35 (53.8%) 13 (65.0%) 15 (65.3%) 7 (31.8%)
> 65 let 22 (33.8%) 0 7 (30.4%) 15 (62.2%)
Weight [kg] 67.9 ± 15.3 66.6 ± 16.0 70.0 ± 13.7 67.0 ± 16.8 0.738
Height [m] 1.7 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 1.7 ± 0.1 0.576
BMI 23.2 ± 4.2 22.3 ± 4.3 24.1 ± 4.0 23.0 ± 4.2 0.333
PEI (< 26.8)# 22 (33.8%) 0 11 (47.8%) 11 (50.0%) 0.001
Pancreatic elastase (mcg/g) 349.8 ± 182.1 440.2 ± 126.3 312.2 ± 188.8 307.0 ± 195.2 0.026
Normal 50 (76.9%) 20 (100%) 16 (69.6%) 14 (63.6%)
Mild decrease 7 (10.8%) 0 2 (8.7%) 5 (22.7%)
Moderate decrease 2 (3.1%) 0 2 (8.7%) 0
Severe decrease 6 (9.2%) 0 3 (13.0%) 3 (13.6%)
Chymotrypsin (U/g) 225.3 ± 160.8 301.7 ± 187.4 181.9 ± 130.3 201.3 ± 144.8 0.033
Normal 52 (80.0%) 20 (100%) 14 (60.9%) 18 (81.8%)
PEI 13 (20.0%) 0 9 (39.1%) 4 (18.2%)
Smoking 0.445
No 56 (86.2%) 19 (95.0%) 18 (78.3%) 19 (86.4%)
< 15 cigarettes /day 4 (6.2%) 0 3 (13.0%) 1 (4.5%)
> 15 cigarettes /day 5 (7.7%) 1 (5.0%) 2 (8.7%) 2 (9.1%)
Coffee 0.136
No 23 (35.4%) 4 (20.0%) 7 (30.4%) 12 (54.5%)
1−2 cups /day 29 (44.6%) 10 (50.0%) 12 (52.2%) 7 (31.8%)
> 2 cups /day 12 (18.5%) 6 (30.0%) 3 (13.0%) 3 (13.6%)
Alcohol 0.108
No 47 (72.3%) 12 (60.0%) 15 (65.2%) 17 (77.3%)
< 2 units/day 16 (24.6) 8 (40.0%) 5 (21.7%) 3 (13.6%)
> 2 units/day 2 (3.1%) 0 0 2 (9.1%)
Cholesterol (mmol/l) 4.5 ± 0.8 4.5 ± 0.7 4.4 ± 1.0 4.5 ± 0.7 0.736
HDL_cholesterol 1.5 ± 0.5 1.5 ± 0.4 1.4 ± 0.4 1.5 ± 0.6 0.637
LDL_cholesterol 2.5 ± 0.7 2.5 ± 0.6 2.5 ± 0.8 2.5 ± 0.7 0.921
Triglycerides 1.2 ± 0.8 0.9 ± 0.2 1.2 ± 0.9 1.5 ± 0.9 0.033

Percent of exhaled 13C in patients with pancreatic exocrine insufficiency (PEI) and without PEI at respective timepoint of 13C measurement

PEI p-value*
Positive < 26.8 (n = 22) Negative > 26.8 (n = 43)
30 min 0.29 ± 0.71 0.47 ± 0.62 0.233
60 min 0.97 ± 1.87 2.23 ± 2.00 0.034
90 min 2.05 ± 2.96 5.23 ± 3.24 < 0.001
120 min 3.53 ± 3.94 8.85 ± 4.05 < 0.001
150 min 8.39 ± 6.36 20.88 ± 5.96 < 0.001
180 min 10.12 ± 7.03 25.07 ± 6.63 < 0.001
210 min 12.21 ± 7.37 29.33 ± 7.29 < 0.001
240 min 14.50 ± 7.66 33.52 ± 8.06 < 0.001
270 min 17.10 ± 8.25 37.33 ± 9.09 < 0.001
300 min 17.72 ± 9.44 40.76 ± 10.43 < 0.001

Percent of exhaled 13C according to diagnosis of in respective timepoint of C13 measurement

Healthy controls (n = 20) Diagnosis
 p-value* p-value**
Subtotal resection (n = 23) Total resection (n = 22)
30 min 0.54 ± 0.74 0.32 ± 0.71 0.38 ± 0.51 0.700 0.936
60 min 2.28 ± 2.32 1.27 ± 1.88 1.92 ± 1.86 0.193 0.534
90 min 5.12 ± 3.76 3.15 ± 3.12 4.32 ± 3.45 0.202 0.495
120 min 8.63 ± 4.76 5.669 ± 4.54 7.04 ± 4.63 0.162 0.593
150 min 20.60 ± 7.09 13.96 ± 9.00 15.87 ± 8.11 0.056 0.714
180 min 24.91 ± 7.86 16.94 ± 10.74 18.77 ± 9.00 0.031 0.790
210 min 29.31 ± 8.61 20.45 ± 12.33 21.51 ± 9.55 0.023 0.937
240 min 33.67 ± 9.26 24.18 ± 13.81 24.14 ± 10.11 0.014 1.000
270 min 37.71 ± 9.82 28.04 ± 15.26 26.47 ± 10.63 0.010 1.000
300 min 41.14 ± 10.40 32.01 ± 17.21 28.51 ± 11.00 0.008 0.658
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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