Is the fat breath test effective in the diagnosis of fat malabsorption and pancreatic disease?

An attempt was made to evaluate the diagnostic effectiveness of the 14CO2-tripalmitin breath test in the screening or diagnosis of fat malabsorption. The differential absorption of 14C-tripalmitin and palmitic acid was evaluated in the diagnosis of pancreatic insufficiency. 24 controls, 13 patients with steatorrhea and 6 with pancreatic disease (4 of them with sufficiency) were studied. 81 breath tests were performed using 75 ml sour cream as a carrier. In 11 cases the 14C-tripalmitin test was repeated using 27 g corn oil as carrier. Both the 14C-tripalmitin and 14C-palmitic acid breath tests failed to provide any discrimination between normals and patients with fat malabsorption. Variation in type and amount of the carrier fat did not alter these results. 14C-tripalmitin absorption was distinctly abnormal in the patients with pancreatic insufficiency. The differential absorption of 14C-tripalmitin and 14C-palmitic acid provided an even better separation between patients with and without pancreatic disease. In contrast to some other investigators we did not find the 14C-tripalmitin and/or palmitic acid breath tests useful in the diagnosis or screening of fat malabsorption. These tests appear promising in the diagnosis of pancreatic disease.