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[13C]0ctanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients: Validation and relationship to gastric symptoms and cardiovascular autonomic function

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 autonomie 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 Weath (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, HbAlc, 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 ti1/2scint (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.

Abbreviations

CAN:

Cardiovascular autonomie neuropathy

CV:

coefficient of R-R interval variation

GEC:

gastric emptying coefficient

LF:

low-frequency

MCR:

mean circular resultant

MF:

mid-frequency

ROI:

region of interest; t1/2breath, breath test half-emptying time

t1/2scint :

scintigraphic half-emptying time.

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Correspondence to D. Ziegler or P. Schadewaldt or A. Pour Mirza or R. Piolot or B. Schommartz or M. Reinhardt or H. Vosberg or H. Brösicke or E. A. Gries.

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Ziegler, D., Schadewaldt, P., Pour Mirza, A. et al. [13C]0ctanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients: Validation and relationship to gastric symptoms and cardiovascular autonomic function. Diabetologia 39, 823 (1996). https://doi.org/10.1007/s001250050516

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Keywords

  • Gastric emptying
  • diabetic gastroparesis
  • scintigraphy
  • breath test
  • cardiovascular autonomic function