Estimation of exocrine pancreatic insufficiency in children with acute pancreatitis using the 13C mixed triglyceride breath test |
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| Affiliation: | 1. Department of Paediatric Surgery, St. John''s Medical College Hospital, India;2. Division of Nutrition, St. John''s Research Institute, Bangalore, India;3. Department of Biostatistics, St. John''s Medical College Hospital, India;4. Department of Physiology, St. John''s Medical College Hospital, India;1. Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan;2. Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Japan;1. Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France;2. Department of Medical Oncology, Poitiers University Hospital, Poitiers, France;3. Department of Medical Oncology, Godinot Cancer Institute, Reims, France;4. Department of Hepato-Gastro-enterology, Poitiers University Hospital, Poitiers, France;5. Department of Digestive and Oncological Surgery, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France;6. Department of Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France;7. Department of Medical Oncology, CHU Lille, University of Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020 - UMR-S 1277, Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France;8. Department of Hepatogastroenterology, CHU Saint Etienne, Saint-Priest-en-Jarez, France;1. Department of Pediatrics (Division of Pediatric Gastroenterology), UH Rainbow Babies & Children''s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA;2. Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA;3. Department of Pediatrics, West Virginia University, Charleston, WV, 25304, USA;1. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;3. Department of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA;4. Department of Radiology, Amsterdam UMC, University of Amsterdam, the Netherlands;5. Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands;6. Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;7. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands |
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| Abstract: | Background/Objective: The extent of exocrine pancreatic insufficiency (EPI) in the paediatric population with acute pancreatitis (AP) is unknown. The primary objective was to use a 6 h stable-isotope breath test to determine the prevalence of EPI in children with AP. The secondary objective was to determine the diagnostic ability of a 4 h abbreviated breath test in the detection of EPI.Methods13C-mixed triglyceride (MTG) breath test was used to measure fat digestibility in 12 children with AP and 12 normal children. EPI was diagnosed based on a cumulative dose percentage recovery (cPDR) cut-off value < 26.8% present in literature. To reduce the test burden, the diagnostic accuracy of an abbreviated 4 h test was evaluated, using a cPDR cut-off that was the 2.5th percentile of its distribution in control children.ResultsThe cPDR of cases was significantly lower than that of controls (27.71 ± 7.88% vs 36.37 ± 4.70%, p = 0.005). The cPDR during acute illness was not significantly different to that at 1 month follow up (24.69 ± 6.83% vs 26.98 ± 11.10%, p = 0.52). The 4 h and 6 h breath test results correlated strongly (r = 0.93, p < 0.001) with each other. The new 4 h test had 87.5% sensitivity and 93.8% specificity for detecting EPI.ConclusionTwo-thirds (66.7%) of this sample of children with AP had EPI during admission, which persisted at 1 month follow up. The 4 h abbreviated 13C-MTG breath test has good diagnostic ability to detect EPI in children and may improve its clinical utility in this age group. |
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