Lipid Digestion in Cystic Fibrosis: Comparison of Conventional and High-Lipase Enzyme Therapy Using the Mixed-Triglyceride Breath Test

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Abstract

Background:

Fat maldigestion occurs in most patients with cystic fibrosis. Conventional pancreatic enzyme replacement therapy partially corrects this defect. In this study, the mixed-triglyceride breath test was used to evaluate whether high-lipase enzymes are equivalent to conventional enzymes in improving fat maldigestion in children with cystic fibrosis.

Methods:

Fat digestion was studied in 11 patients with a mean age of 10.5 years. The mean intake of conventional enzyme capsules a day was 19. Four 13C mixed-triglyceride tests were performed on separate days and in random order. One test was taken without enzyme substitution, one with three capsules of 8,000 FIP units Creon (pancreatinum, Kali-chemie Pharma, Hannover, Germany) and one with one capsule of 25,000 FIP units. The fourth test was made with13 C octanoic acid to study gastric emptying time.

Results:

Without enzyme intake, the mean cumulative percentage of 13C dose exhaled after 6 hours was 7.2 ± 3.7%. This increased to 14.4 ± 4% with intake of conventional pancreatinum and to 14.3 ± 5.1% with intake of high-lipase pancreatinum (p = 0.0008 for both; pairedt-test). There was no difference between both treatments. Also, the time course of 13C exhalation measured by percentage of13 CO2 exhaled per hour did not differ between enzyme treatments.

Conclusions:

The 13C mixed-triglyceride test is noninvasive and documents improved lipid digestion with pancreatic enzyme replacement therapy. If the lipase dose is kept constant, results obtained with high-lipase preparations are equivalent to those obtained with conventional preparations.

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