TY - JOUR
T1 - Preliminary report of the 13C-mixed triglyceride breath test to assess timing of pancreatic enzyme replacement therapy in children with cystic fibrosis
AU - Vanderhaak, Natalie
AU - Boase, Julia
AU - Davidson, Geoffrey
AU - Butler, Ross
AU - Miller, Michelle
AU - Kaambwa, Billingsley
AU - Kritas, Stamatiki
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Despite guidelines suggesting pancreatic enzyme replacement therapy (PERT) should be taken before or during a meal, it is currently unknown whether this has benefits over administration after a meal in individuals with cystic fibrosis (CF). Methods 18 children with pancreatic insufficient CF were randomised to two 13C-mixed triglyceride (13C-MTG) breath tests to assess lipase activity with PERT administered 10 min before and 10 min after a meal. Results were expressed as percentage cumulative dose recovered (PCDR) of 13CO2 and were compared with established values in healthy subjects. Gastric half emptying time (T½) was also assessed by a 13C-octanoate breath test. Results There was no difference in mean PCDR of 13CO2 between taking PERT before versus after the meal (p = 0.68). Eleven subjects had a greater PCDR when PERT was taken before and 7 when PERT was taken after the meal. 6/8 subjects (75%) with a lower than normal PCDR at one time point normalised PCDR when PERT timing was changed. When PERT was taken after the meal, PCDR was higher in normal vs. fast T½ (p = 0.04). Conclusions Changing PERT timing can result in normalised lipase activity. Gastric emptying rate may influence optimal timing of PERT. Clinical Trial Registration Number — This study was undertaken prior to the registration process being a commonly required practice.
AB - Background Despite guidelines suggesting pancreatic enzyme replacement therapy (PERT) should be taken before or during a meal, it is currently unknown whether this has benefits over administration after a meal in individuals with cystic fibrosis (CF). Methods 18 children with pancreatic insufficient CF were randomised to two 13C-mixed triglyceride (13C-MTG) breath tests to assess lipase activity with PERT administered 10 min before and 10 min after a meal. Results were expressed as percentage cumulative dose recovered (PCDR) of 13CO2 and were compared with established values in healthy subjects. Gastric half emptying time (T½) was also assessed by a 13C-octanoate breath test. Results There was no difference in mean PCDR of 13CO2 between taking PERT before versus after the meal (p = 0.68). Eleven subjects had a greater PCDR when PERT was taken before and 7 when PERT was taken after the meal. 6/8 subjects (75%) with a lower than normal PCDR at one time point normalised PCDR when PERT timing was changed. When PERT was taken after the meal, PCDR was higher in normal vs. fast T½ (p = 0.04). Conclusions Changing PERT timing can result in normalised lipase activity. Gastric emptying rate may influence optimal timing of PERT. Clinical Trial Registration Number — This study was undertaken prior to the registration process being a commonly required practice.
KW - Cystic fibrosis
KW - Gastric emptying
KW - Lipase activity
KW - Pancreatic enzyme replacement therapy
UR - http://www.scopus.com/inward/record.url?scp=84963829100&partnerID=8YFLogxK
U2 - 10.1016/j.jcf.2016.03.008
DO - 10.1016/j.jcf.2016.03.008
M3 - Article
SN - 1569-1993
VL - 15
SP - 669
EP - 674
JO - Journal of Cystic Fibrosis
JF - Journal of Cystic Fibrosis
IS - 5
ER -