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Biomedical subjects

B Lembcke

Publications and source records attributed to B Lembcke.

At least 19 recordsLinked to original sources
PubMed1998

Risk of gastrointestinal bleeding associated with Helicobacter pylori infection in patients with hemophilia or von Willebrand's syndrome.

BACKGROUND: Many episodes of bleeding in the upper gastrointestinal tract are caused by Helicobacter pylori infection. Because these episodes present a life-threatening complication in patients with bleeding disorders, we prospectively investigated the prevalence of H. pylori infection in patients with hemophilia A or B and with the von Willebrand syndrome. METHODS: Seventy patients (54 men, 16 women, ages 40 +/- 11 years) and 100 age-related volunteers (63 men, 37 women, ages 39 +/- 9 years) were tested for H. pylori infection using the 13C urea breath test. Fifty-four patients with hemophilia and 16 patients with von Willebrand syndrome participated. RESULTS: Thirty-three (33%) of the controls and 24 (34.3%) of the patients showed positive 13C urea breath tests (p = .97). Nineteen (35.2%) patients with hemophilia and 5 (31.3%) patients with von Willebrand syndrome were positive for H. pylori. History of dyspeptic symptoms (28% vs. 26%) were not different in patients and controls (p = .91). Gastric ulcers (20% vs. 5%) and duodenal ulcers (7% vs. 5%) were diagnosed more often in patients with bleeding disorders. Fourteen of the patients (20%), but none of the controls had a history of gastrointestinal bleeding (p < .001). CONCLUSIONS: The rate of H. pylori infection and dyspepsia in patients with bleeding disorders is similar to the prevalence in the normal population. Due to increased bleeding complications, H. pylori screening and therapy appears mandatory in patients with bleeding disorders.

Adult↗
PubMed1998

Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy is not without risks, and is also ineffective in about half of patients with type III sphincter of Oddi dysfunction (SOD), i.e. those without clinical evidence of biliary obstruction (normal liver tests, normal bile duct diameter, and regular drainage time at endoscopic retrograde cholangiography). The present study therefore investigated the efficacy and safety of endoscopic botulinum toxin (BTX) injection into the papilla of Vater, and analyzed whether the symptomatic response to BTX injection might be a predictor of outcome for endoscopic sphincterotomy. PATIENTS AND METHODS: Twenty-two patients who had undergone cholecystectomy and had manometrically confirmed type III SOD were enrolled during a three-year study period. All patients received treatment with an endoscopic single-shot injection of 100 mouse units of BTX into the papilla of Vater. Initial symptomatic responses were analyzed six weeks later. If the BTX injection had been ineffective, or if biliary symptoms recurred after initial benefit during the follow-up period, endoscopic manometry and endoscopic sphincterotomy were performed. All patients then received further prospective clinical follow-up examinations. RESULTS: With the exception of one patient with mild pancreatitis (4.5%), no side effects were observed after endoscopic BTX injection. Six weeks after BTX injection, 12 SOD patients (55%) were symptom-free, but ten patients (45%) were not. However five of these ten SOD patients who did not experience symptomatic benefit from BTX injection had normal basal sphincter of Oddi pressures (< 40 mmHg) at this time, and none of these five patients was free of complaints after subsequent endoscopic sphincterotomy. Two of the remaining five patients with sustained sphincter hypertension after BTX injection benefitted from endoscopic sphincterotomy. Eleven of the 12 SOD patients who had initially responded to BTX injection developed recurrent symptoms after a median period of six months. Manometry revealed sphincter hypertension in all 11 cases, and all patients became free of complaints again after endoscopic sphincterotomy during a median follow-up of a further 15 months. Overall, 11 of the 12 patients who responded to BTX injection, versus two of the ten patients who did not gain pain relief after BTX injection, later benefitted from endoscopic sphincterotomy (p < 0.01). CONCLUSIONS: Endoscopic injection of botulinum toxin into the papilla of Vater is a safe procedure and provides short-term relief of symptoms in half of patients with type III SOD. Our results also indicate that the clinical response to BTX injection can predict whether SOD patients will gain long-term benefit from endoscopic sphincterotomy.

Adult↗
PubMed1998

[Structure and quality of German-language gastroscopy information forms from the patients' viewpoint].

UNLABELLED: Information about procedure and risks is prerequisite for obtaining informed consent for endoscopy. This prospective and randomized investigation evaluated (i) the extent of patients' information needs and (ii) the formal quality (language, ease of understanding, length, figures etc.) of three information forms concerning upper CI-endoscopy issued in 1995 by DIOmed (1), perimed compliance (2), and PERIMED-spitta (3) as judged by the patients. (iii) Outcome quality was investigated as the influence of these forms on understanding why and how endoscopy was performed as well as the influence on feeling threatened. Furthermore patients' anxiety was assessed by using Spielberger's state-trait anxiety inventory (STAI). 218 patients completed the investigation (n = 73; 70; 75, respectively). 60% claimed the need for a detailed explanation of the planned endoscopy and 48% said they wanted exhaustive informations about potential complications and risks. The three forms (length 819, 771, 1,245 words) were entirely read by 87%, 89% and 82% of the patients. Positive language, adequate length (69%, 69%, 71%) and adequate layout were evenly attributed to the three forms. A high impact of the figures for understanding was found more frequently (48%, 46%, 35%) with (1) and (2) and language war regarded easy by 57%, 54% and 44%, respectively. Flesh's reading ease score, however, proved a sophisticated niveau of language with all three forms. The indication for endoscopy (37%, 49%, 56%) and explanation of performance (43%, 43%, 63%) was superior with (3). This form also reduced anxiety as judged by STAI-means, overall STAI-changes, and relevant changes (> or = 5 points). Form (2) increased patients' anxiety. CONCLUSION: While the formal quality of all information forms is appreciated by patients both their reading ease score and figures should be improved. A significant reduction of anxiety can be achieved by appropriate selection of the information material.

Adult↗
PubMed1998

[Intestinal ultrasound in rare small and large intestinal diseases].

Intestinal ultrasonography is a meanwhile established and valid diagnostic method in inflammatory bowel disease, diverticulitis, and appendicitis. Little, however, is known about other more rare intestinal diseases. Serving as a tertiary referral center for a broad spectrum of intestinal diseases we therefore report some aspects of ultrasonography in patients with acute and chronic enteritis and colitis of different origin, e.g., bacterial and viral colitis, ileocecal tuberculosis, AIDS-related enteritis, neutropenic colitis, cystic fibrosis, celiac sprue, vasculitis, benign and malignant tumors of the intestine, amyloidosis, ischemic colitis, and radiogenic enteritis. Ultrasonography may display the transformation of the intestinal wall from normal to pathological states both in inflammatory and neoplastic disease. Besides demonstrating the transmural aspect of inflammation it also shows the mesenteric reaction as well as complications such as fistula, abscesses, stenosis, or ileus. Furthermore, in some diseases intestinal ultrasonography may serve as a diagnostic clue if typical patterns of the bowel wall and impaired peristalsis can be demonstrated. This may lead to an important reduction of invasive and expensive procedures. Ultrasonography is of definite help in the follow-up of inflammatory changes of the bowel wall and primarily diagnostic with respect of other entities (e.g., penicillin-induced segmental hemorrhagic colitis). A sonographic differential diagnosis of diseases of the bowel wall on a purely morphological basis, however, is difficult and rather the exception than the rule. The information gained by ultrasonography regarding intestinal disease, however, is as important and valid as e.g., in case of focal lesions of the liver.

Colitis↗
PubMed1997

[Breath tests in intestinal diseases and functional gastrointestinal diagnosis].

Among the numerous breath tests described for gastroenterological applications, breath hydrogen (H2) tests have emerged during the past two decades as a most sensitive, reliable and feasible method for detecting carbohydrate malabsorption and maldigestion (e. g. lactose maldigestion). Hence they are regarded time honored standards of contemporary gastroenterological function tests. For the diagnosis of the small bowel bacterial overgrowth syndrome the glucose H2 breath test is a feasible tool with moderate sensitivity (approximately 65%), which, however, is not higher with alternative breath test (e. g. the 1 g 14C-D-xylose breath test). Measuring mouth-to-caecum-transit time by the breath H2 response after lactulose is more of scientific interest than clinically informative. Breath tests making use of 14C labeled substrates (usually 5 to 10 microCi) bear a rather low calculated radiation hazard and are thus in routine use in some countries, e. g. in Scandinavia, but they are abandoned in others. At least, however, radioactive 14C breath tests are (partially) dispensible, as these restrictions do not apply for the stable isotope 13C breath tests which are nonradioactive and thus devoid of any radiation hazard. For the purpose of gastroenterological function testing the 13C urea breath test for the detection of Helicobacter pylori infection, quantitative studies of gastric emptying with 13C-acetate or 13C-octanoate and quantitative liver function tests have gained diagnostic use while 13C-breath tests assessing intestinal absorption or exocrine pancreatic function have been found less effective than the respective alternatives, or too expensive. Both, H2-breath tests and 13CO2-breath tests are clinically important, diagnostic methods with well delineated indications in gastroenterology.

Breath Tests↗
PubMed1997

Endoscopy is not a risk factor for Helicobacter pylori infection--but medical practice is.

BACKGROUND: Previous studies have suggested an increased risk for Helicobacter pylori infection in physicians who perform UGI endoscopy because of exposure to potentially infectious gastric secretions. Therefore, the H. pylori infection status of the endoscopy staff was compared with the H. pylori prevalence of medical staff without endoscopy experience and control subjects who had no contact with patients. METHODS: The noninvasive 13C-urea breath test was performed in 2108 volunteers: 1460 physicians (mean age 44 +/- 12 years), 235 nurses (33 +/- 10 years), and 413 control subjects (43 +/- 12 years) who were not working in clinical medicine. All subjects completed a questionnaire concerning the weekly frequency of gastroscopies and the duration of endoscopic experience. RESULTS: Overall, 37.4% of the physicians and 35.3% of the nurses, but only 27.1% of the control subjects were infected. H. pylori infection was not significantly different between endoscopy-performing (37.8%; n = 1091) and general medical staff (35.9%; n = 604). Neither the frequency of gastroscopies nor the duration of endoscopy practice correlated with H. pylori status. With respect to the age distribution; however, a statistically significant higher prevalence of H. pylori was observed in physicians and nurses compared with the 413 control subjects without patient contact (p < 0.01). CONCLUSION: UGI endoscopy is not a risk factor for H. pylori infection, but medical practice slightly raises H. pylori acquisition.

Adult↗
PubMed1997

Density of gastric Helicobacter pylori colonization is not associated with occurrence of dyspeptic symptoms.

In most studies, the prevalence of Helicobacter pylori infection in patients with dyspeptic symptoms does not clearly differ from the prevalence in asymptomatic controls. However, the degree of H. pylori colonization might play a role for the occurrence and severity of dyspeptic symptoms. Between August 1993 and July 1994, we screened 1500 apparently healthy volunteers (1036 men, 464 women, 42 +/- 12 years) for H. pylori infection using the [13C] urea breath test. The noninvasive urea breath test enables a semiquantitative assessment of the extent of H. pylori colonization in the stomach. Of the 1500 volunteers, 526 (35.1%) complained of occasional or frequent dyspeptic symptoms. No difference was observed in the H. pylori prevalence between asymptomatic subjects (35.5%) and those with dyspeptic symptoms (35.9%; P > 0.95). A high density of H. pylori colonization in the gastric mucosa was not associated with a higher frequency of dyspepsia (P > 0.80). According to these findings, an eradication therapy on the basis of dyspeptic symptoms alone cannot be recommended as H. pylori is not a proven etiology of dyspepsia.

Adolescent↗
PubMed1997

Ultrasound studies of the intestinal wall in patients with cystic fibrosis.

BACKGROUND: In 1994, first published reports described cystic fibrosis patients who experienced a then unknown complication-ileocecal and colonic stenoses with submucosal proliferation requiring surgical intervention. To investigate a suspected correlation between increased intestinal wall diameter and high doses of pancreatic enzymes, we carried out a prospective study in our CF-outpatient clinic. METHODS: By ultrasound analysis we measured the intestinal wall diameter in 201 patients. One hundred ninety-three patients treated with pancreatic enzymes had pancreatic insufficiency. Eight patients showed normal pancreatic function, seven of them had never been treated with pancreatic enzymes. The control group included 12 healthy children. Measuring points were the distal ileum, cecum, ascending, and descending colon. Measurements were made by the longitudinal and cross sectional cut. The following aspects of the patients' history were recorded (a) current type of pancreatic enzyme medication; (b) total dosage per day (with reference to lipase units); (c) duration of therapy with standard-strength pancreatic enzyme (SSPE) preparations (< or = 10,000 lipase units per capsule) and HSPE preparations (> or = 20,000 lipase units per capsule); (d) gastrointestinal complication (distal intestinal obstruction syndrome, meconium ileus, abdominal surgery, intussusception), diabetes mellitus, and hepatobiliary complications. RESULTS: The intestinal wall diameter in patients receiving HSPE therapy was greater (with prominent submucosal layer) than that in patients receiving SSPE therapy or in patients with pancreatic sufficiency. Healthy subjects had the smallest intestinal wall diameter. There was no correlation between patient history and increased intestinal wall thickness. CONCLUSIONS: Ultrasound detects characteristic ileocecal wall lesions in the majority of cystic fibrosis patients on pancreatic enzymes. These lesions may lead to significantly increased ileocecal wall thickness, which is correlated but not restricted to HSPE.

Adolescent↗
PubMed1997

Causes and management of recurrent biliary pain after successful nonoperative gallstone treatment.

OBJECTIVE: To evaluate the frequency and causes of recurrent biliary colic after successful extracorporeal shock wave lithotripsy of gallstones. METHODS: Follow-up of 77 patients for 2 yr (median) after complete gallstone clearance by lithotripsy and adjuvant oral litholysis. All patients with recurrent biliary colic were examined thoroughly (laboratory data, ultrasonography, gastroscopy); the examination included gallbladder motility testing. If the patients suffered from additional gastrointestinal complaints, further symptom-guided investigations (pH-metry, lactose absorption study, enteroclysis, colonic transit time, colonoscopy) were performed. Patients without documented gallstone recurrence underwent ERCP and sphincter of Oddi manometry. Cholecystectomy was advised for patients in whom gallstones recurred, and patients with sphincter of Oddi dysfunction underwent endoscopic sphincterotomy. If other gastrointestinal disorders were diagnosed, appropriate treatment was initiated. RESULTS: Twenty-seven patients (35%) experienced biliary colic during follow-up. Gallstone recurrence was documented in 17 patients, and 16 of the patients who underwent cholecystectomy became symptom-free again (follow-up: 12 months). Gallbladder hypomotility was revealed in seven of the 17 patients with gallstone recurrence compared to none of the 10 patients without gallstone recurrence (p < 0.05). Microlithiasis was not detected in bile samples from the patients whose gallstones did not recur. Sphincter of Oddi dysfunction was found in four patients, and sphincterotomy cured all of them (follow-up: 9 months). Two of the remaining six patients had functional gastrointestinal disorders (reflux, constipation) and became asymptomatic after specific treatment. CONCLUSIONS: Biliary colic often recurs after successful gallstone lithotripsy. Recurrent gallbladder stones are the main cause, but another cause is sphincter of Oddi dysfunction. Neither gallbladder hypomotility nor microlithiasis seems to cause biliary symptoms in patients without recurrence of gallstones.

Adult↗
PubMed1997

Monitoring pancreatin supplementation in cystic fibrosis patients with the 13C-Hiolein breath test: evidence for normalized fat assimilation with high dose pancreatin therapy.

BACKGROUND: 13C-Hiolein is a randomly 13C-labeled mixture of long chain triglycerides synthesized by algae. METHODS: Because the 13C-Hiolein breath test is a suitable noninvasive tool to detect and monitor pancreatic steatorrhea, we used this new breath test for monitoring the effect of enzyme replacement therapy with an acid resistant enteric coated polydisperse pancreatin preparation (1.500 U/kg d) in children with cystic fibrosis. RESULTS: Administration of 1.5 mg/kg 13-C-Hiolein together with a physiological mixed meal (1.5 g/kg rice cookies, containing 25% fat and 37% starch) resulted in significantly higher breath 13CO2/12CO2 ratios in controls than in cystic fibrosis children (maximal delta over baseline responses (DOBmax) 39.2 +/- 18.1% vs. 13.1 +/-13.9%; p < 0.001). With pancreatin, DOBmax in the cystic fibrosis patients responses returned completely to normal (39.2 +/- 29.2% DOBmax). A breath hydrogen increase indicating the malassimilation of starch was noticed in one patient with severe pancreatic insufficiency only. CONCLUSION: In contrast to fecal fat analysis, the 13C-Hiolein breath test reflects postprandial fat assimilation immediately after a given, labeled meal. Monitoring the oxidative fate of physiological test meal with a stable isotope breath test, this study shows that fat assimilation in cystic fibrosis patients can be normalized with high dose pancreatin.

Adolescent↗
PubMed1997

[Do ultrasound parameters allow diagnosis of biliary sphincter of Oddi dysfunction?].

UNLABELLED: A noninvasive test to prove sphincter of Oddi dysfunction is desired, because endoscopic manometry is technically demanding and not without risks. METHODS: 40 consecutive patients (n = 20 patients with, and n = 20 patients without enzymatic cholestasis) with suspected SOD were investigated both by ultrasonography (US; 3.5 MHz) and by endoscopic manometry. SOD was suspected at US if the extrahepatic bile duct diameter was > or = 9 mm and a further increase (at least > 0.5 mm) was observed after intravenous ceruletide (0.3 micrograms/kg b.w.). SOD was verified manometrically by a sphincter of Oddi basal pressure > or = 40 mmHg. Endoscopic sphincterotomy was performed if SOD was diagnosed by manometry. Thereafter, all patients were enrolled in a prospective follow-up (median: one year). RESULTS: At US SOD was suspected in eleven of 20 patients with cholestasis. SOD was confirmed manometrically in all of them but also in two further patients (13 of 20 patients with proven SOD). After EST twelve of 13 patients remained free from biliary symptoms. In the 20 patients without cholestasis SOD was suspected at US in five patients only. However, endoscopic manometry revealed SOD in eleven of 20 patients and proved sonographically presumed SOD in only three of five patients. After EST only three of eleven patients remained asymptomatic during follow-up (p < 0.05 vs. patients with cholestasis). Clinically important side effects were not observed after ceruletide administration, whereas postmanometry pancreatitis was observed in three of 40 patients. CONCLUSION: In patients with recurrent symptoms after cholecystectomy and enzymatic cholestasis SOD was reliably diagnosed by ultrasonography (sensitivity: 85%, specificity: 100%), and this finding may guide endoscopic sphincterotomy.

Adult↗
PubMed1997

Sonographic detection of focal changes in the liver hilus in patients receiving corticosteroid therapy.

OBJECTIVE: While diffuse deposition of fat may occur with corticosteroid (CS) administration both in the liver and in other organs, comparatively little is known about focal changes in the liver under corticosteroid medication. Therefore, we evaluated pattern and extent of focal hepatic steatosis by ultrasound (US) in patients receiving corticosteroids. SUBJECTS AND METHODS: 93 patients with known inflammatory bowel disease (IBD) received corticosteroids during a period of at least six weeks prior to the ultrasound examination and 28 IBD-patients had no corticosteroids within the last three years. 13 additional patients received corticosteroids for other reasons than IBD for > 1 year. 80 healthy volunteers served as controls. Focal changes of the liver as assessed by high resolution ultrasound (Acuson 128, 3.5 and 5 MHz) were defined as areas of brighter echogenicity compared to the general aspect of the liver. The size of the hyperechoic areas was documented (photoprint). RESULTS: 40/93 IBD-patients with corticosteroids (43%) had definite areas of brighter echos in the hilus region of the liver. In IBD-patients without corticosteroids only one patient showed a focal brighter echogenicity, whereas in the non-IBD group with corticosteroids 8/13 had focal lesions (62%). In the control group only four healthy subjects showed brighter areas (5%). CONCLUSION: Bright focal areas in the liver hilus occur in > 40% of IBD-patients during corticosteroid medication. This phenomenon occurs in IBD-patients as frequently and as intense as in other patients with longstanding corticosteroid therapy. There is a hilar area of the liver with typical size and location which reacts to corticosteroid administration with hyperechoic reflexes at ultrasound investigation. This is important to know when it comes to the differential diagnosis of focal changes.

Adrenal Cortex Hormones↗
PubMed1996

Do patients with sphincter of Oddi dysfunction benefit from endoscopic sphincterotomy? A 5-year prospective trial.

OBJECTIVES: To assess the incidence of elevated sphincter of Oddi baseline pressure and the response to endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction. DESIGN: A 5-year prospective clinical trial. METHODS: One-hundred and eight patients with recurrent biliary-type pain after cholecystectomy were enrolled. After thorough investigation, 35 patients with suspected type II sphincter of Oddi dysfunction (SOD) and another 29 type III patients remained for further investigation. Both groups were similar with respect to demographic data and severity of pain. Biliary manometry was performed in all except three patients in either group. Endoscopic sphincterotomy was performed in all patients with abnormal sphincter of Oddi baseline pressure (> 40 mmHg). All patients were clinically re-evaluated after 4-6 weeks, and thereafter the sphincterotomized patients were followed for a median period of 2.5 years. RESULTS: An abnormal sphincter of Oddi baseline pressure was found in 62.5% of the type II patients and in 50% of the patients with suspected type III SOD (P = 0.66). At the 4-6 week follow-up none of those patients without abnormal manometry, but 70% of the patients with type II SOD, and 39% of the type III SOD patients, respectively, reported subjective benefit after sphincterotomy (P = 0.13 type II vs. type III). However, after a median follow-up of 2.5 years, sustained symptomatic improvement after sphincterotomy was found in 60% of the type II patients, but only in 8% of the patients with type III SOD (P < 0.01). CONCLUSION: Disregarding a lack of difference in the incidence of abnormal sphincter of Oddi baseline pressure between type II and type III SOD, the Geenen-Hogan classification helps to predict the clinical outcome after endoscopic sphincterotomy.

Cholecystectomy↗
PubMed1996

Dose-response of omeprazole combined with amoxycillin on duodenal ulcer healing and eradication of Helicobacter pylori.

BACKGROUND: Combination therapy using omeprazole and amoxycillin can cure Helicobacter pylori infection, but data are controversial concerning the efficacy of this regimen. The present study investigated varying doses of omeprazole combined with a standard amoxycillin dose on duodenal ulcer healing and eradication of H. pylori, in order to find an optimal dose regimen. METHODS: H. pylori-positive out-patients (n = 231) with duodenal ulcers were treated randomly and double-blind with either omeprazole 20, 40 or 80 mg b.d. plus amoxycillin 1 g b.d. for 14 days. Patients with an unhealed ulcer after this therapy took omeprazole 20 mg o.m. for another month. RESULTS: After 2 weeks, ulcer healing rates in the three treatment groups were not statistically different (85, 82 and 93%, respectively). Treatment with omeprazole 80 mg b.d. was significantly better in curing H. pylori infection (eradication rate 69%) than treatment with omeprazole 20 and 40 mg b.d. (47 and 53%). CONCLUSIONS: Combination of either omeprazole 20 or 40 mg b.d. plus amoxycillin 1 g b.d., is not sufficiently effective to be recommended as an anti-H. pylori therapy. Omeprazole 80 mg b.d. combined with amoxycillin is more efficient and well tolerated, but better treatment options now exist to cure H. pylori infection.

Adult↗
PubMed1996

Exocrine pancreatic insufficiency: accuracy and clinical value of the uniformly labelled 13C-Hiolein breath test.

BACKGROUND AND AIMS: The 13C-Hiolein breath test (98% [U-13C] labelled long chain triglyceride mixture (highly labelled triolein) was evaluated as a non-invasive, non-radioactive test for exocrine pancreatic insufficiency. Accuracy and clinical validity were examined with reference to both the secretin pancreozymin test and faecal fat analysis. METHODS: A secretin pancreozymin test and faecal fat analysis were performed in 46 patients, 30 with exocrine pancreatic insufficiency and 16 with normal pancreatic function. In all of these patients and in seven healthy volunteers (controls), a 13C-Hiolein breath test was performed using 2 mg/kg [U-13C] labelled Hiolein with a standard risk snack (1.5 g/kg; 25% fat). 13CO2/12CO2 enrichment in the exhaled breath was measured by isotope ratio mass spectrometry. RESULTS: In patients with pancreatic steatorrhoea the 13CO2 response was below the 95% confidence interval of 13CO2 exhalation in the controls. These responses were also diminished (p < 0.001) compared with patients with impaired lipase output but normal fat excretion and with disease as well as healthy controls. There was a linear correlation between stimulated lipase output and the ratio of lipase output/13CO2 response (r = 0.95). Among the 40 patients in whom direct pancreatic function testing was clinically indicated, the sensitivity of the 13C-Hiolein test for detecting steatorrhoea was 91.7%, with a specificity of 85.7%. CONCLUSIONS: In patients with pancreatic disease the 13C-Hiolein breath test reflects impaired lipase output and indicates decompensated lipolysis. The 13C-Hiolein breath test is a convenient alternative to faecal fat analysis.

Adult↗
PubMed1996

Nondispersive isotope-selective infrared spectroscopy: a new analytical method for 13C-urea breath tests.

BACKGROUND: Currently, stable isotope techniques in breath tests using 13C-labeled substrates are limited to a few centers equipped with expensive and complex isotope ratio mass spectrometry (IRMS). Although breath samples can be mailed to these centers, widespread application of 13C breath tests would be more feasible with a cheaper and more practicable analysis system at hand. METHODS: We therefore tested the newly developed nondispersive isotope-selective infrared spectrometer (NDIRS) with reference to IRMS in a clinical setting comparing the results of both techniques in 538 consecutive 13C-urea breath tests performed for the detection of Helicobacter pylori infection. RESULTS: With NDIRS five false-positive and three false-negative results were observed; that is, the sensitivity of NDIRS was 98.3%, and the specificity was 98.6%. The delta over base-line values of both devices correlated linearly (Y = 0.87 +/- 0.01 X + 0.29 +/- 1.5; r = 0.95; p < 0.0001; n = 538). CONCLUSIONS: When running this large number of breath tests in 3 days, the NDIRS proved to be a reliable, stable, and easy-to-operate analytical tool, which is well qualified for gastroenterologic application in the diagnostic routine. Both the price and the easy handling of NDIRS will facilitate the widespread use of the noninvasive stable isotope technique for 13C breath tests.

Adult↗
PubMed1996

Immunoreactive elastase I: clinical evaluation of a new noninvasive test of pancreatic function.

We have evaluated the diagnostic value of the fecal elastase test in comparison with the secretin-pancreozymin test in the diagnosis of exocrine pancreatic insufficiency. Pancreatic elastase was measured immunologically. Immunoreactive elastase activity in spot stools from controls ranged from 136 to 4440 microgram/g; 95% of all values were within 175 to 1500 microgram/g. The elastase assay CVs ranged from 3.3% to 6.3% (intraassay) and from 4.1% to 10.2% (interassay). The output of elastase correlated well with those of amylase, lipase, and trypsin, yielding respective correlation coefficients of 0.83, 0.82, and 0.84 in controls and 0.86, 0.91, and 0.91 in patients with impaired pancreatic function. In contrast to fecal chymotrypsin, the test results were unaffected by pancreatic enzyme replacement therapy. These results indicate that fecal immunoreactive elastase may be recommended as a new, noninvasive tubeless test of pancreatic function.

Adolescent↗