Domínguez-Muñoz J Enrique, Iglesias-García Julio, Vilariño-Insua María, Iglesias-Rey Marta
Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Clin Gastroenterol Hepatol. 2007 Apr;5(4):484-8. doi: 10.1016/j.cgh.2007.01.004.
BACKGROUND & AIMS: Malnutrition persists in most patients with chronic pancreatitis despite an adequate clinical response to oral pancreatic enzyme substitution therapy. Our aims were to analyze the accuracy of the 13C-mixed triglyceride breath test as a tool for evaluating the effect of enzyme therapy on fat digestion in chronic pancreatitis, and to analyze the impact of modifying the therapy according to the breath test on patients' nutritional status.
The accuracy of the breath test for monitoring the effect of therapy was evaluated prospectively in 29 patients with maldigestion secondary to chronic pancreatitis by using the coefficient of fat absorption as the gold standard. Therapy was modified to obtain a normal breath test result in a further 20 chronic pancreatitis patients with malnutrition despite an adequate clinical response to the enzyme therapy; the impact of this therapeutic modification on patients' nutritional status was evaluated.
The coefficient of fat absorption and breath test results were similar when assessing fat absorption before and during treatment. Modification of the enzyme therapy to normalize fat absorption as assessed by the breath test in the second group of 20 patients was associated with a significant increase of body weight (P < .001), and serum concentrations of retinol binding protein (P < .001) and prealbumin (P < .001).
The 13C-mixed triglyceride breath test is an accurate method to evaluate the effect of enzyme therapy on fat digestion. This method is simpler than the standard fecal fat test to assess therapy in patients with pancreatic exocrine insufficiency. Normalizing fat absorption improves nutrition in these patients.
尽管大多数慢性胰腺炎患者对口服胰酶替代疗法有充分的临床反应，但营养不良问题仍然存在。我们的目的是分析13C混合甘油三酯呼气试验作为评估酶疗法对慢性胰腺炎脂肪消化效果的工具的准确性，并分析根据呼气试验调整疗法对患者营养状况的影响。
以前瞻性方式，将脂肪吸收系数作为金标准，评估29例慢性胰腺炎继发消化不良患者的呼气试验监测治疗效果的准确性。另外20例慢性胰腺炎营养不良患者，尽管对酶疗法有充分的临床反应，但仍根据呼气试验结果调整治疗方案；评估这种治疗调整对患者营养状况的影响。
在评估治疗前和治疗期间的脂肪吸收时，脂肪吸收系数和呼气试验结果相似。在第二组20例患者中，根据呼气试验结果调整酶疗法以使脂肪吸收正常化，这与体重显著增加（P <.001）、血清视黄醇结合蛋白浓度显著增加（P <.001）和前白蛋白浓度显著增加（P <.001）相关。
13C混合甘油三酯呼气试验是评估酶疗法对脂肪消化效果的准确方法。对于评估胰腺外分泌功能不全患者的治疗，该方法比标准粪脂试验更简单。使脂肪吸收正常化可改善这些患者的营养状况。
