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Exp Clin Endocrinol Diabetes 2022; 130(11): 751-757
DOI: 10.1055/a-1784-6185
Article

Measurement of Gastric Emptying Using a 13C-octanoic Acid Breath Test with Wagner-Nelson Analysis and Scintigraphy in Type 2 Diabetes

Laurence G Trahair‡
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
,
Michael A Nauck‡
2   Diabetes Center Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany
,
Tongzhi Wu
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
3   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
,
Julie E Stevens
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
4   School of Health and Biomedical Sciences, RMIT University, Victoria, Australia
5   Division of Health Sciences, University of South Australia, South Australia, Australia
,
Madeline D Buttfield
5   Division of Health Sciences, University of South Australia, South Australia, Australia
,
Seva Hatzinikolas
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
,
Hung Pham
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
,
Juris J Meier
2   Diabetes Center Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University, Bochum, Germany
,
Christopher K Rayner
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
6   Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
,
Michael Horowitz
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
3   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
,
Karen L Jones
1   Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia
3   Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
5   Division of Health Sciences, University of South Australia, South Australia, Australia
› Author Affiliations Funding This study was funded by a clinical project grant provided by the Royal Adelaide Hospital.
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Abstract

Introduction Breath tests utilising 13C-labelled substrates for the assessment of gastric emptying have been applied widely. Wagner-Nelson analysis is a pharmacokinetic model that can be utilised to generate a gastric emptying curve from the % 13CO2 measured in breath samples. We compared Wagner-Nelson analysis with (i) scintigraphy and (ii) conventional breath test modelling to quantify gastric emptying in type 2 diabetes.

Methods Thirteen patients (age 68.1±1.5 years, body mass index 31.0±0.9 kg/m2, HbA1c 6.3±0.2%) consumed a mashed potato meal comprising 65 g powdered potato, 20 g glucose, 250 ml water, an egg yolk labelled with 100 μL 13C-octanoic acid and 20MBq 99mTc-calcium phytate. Scintigraphic data were acquired and breath samples collected for 4 hours after the meal. Gastric emptying curves were derived based on each technique; the 50% emptying time and intragastric retention at 60 min were also calculated.

Results With Wagner-Nelson analysis, a Kel=0.60 (the elimination constant) best approximated the scintigraphic gastric emptying curve. There was a relationship between the T50 calculated with scintigraphy and by both Wagner-Nelson Kel=0.60 (r2=0.45, P<0.05) and conventional analysis (r2=0.44, P<0.05). There was no significant difference in the 50% gastric emptying time for scintigraphy (68.5±4.8 min) and Wagner-Nelson Kel=0.60 (71.3±4.5 min), however, the 50% gastric emptying time calculated by conventional analysis was much greater at 164.7±6.0 min (P<0.001).

Conclusion In type 2 diabetes, gastric emptying of a mashed potato meal measured using a 13C-octanoic acid breath test analysed with Wagner-Nelson Kel=0.60 closely reflects measurements obtained with scintigraphy, whereas, in absolute terms, the conventional breath test analysis does not.

Keywords

gastric emptying - breath test - scintigraphy - Wagner-Nelson - glucose

Supplementary Material



Publication History

Received: 05 November 2021
Received: 08 February 2022

Accepted: 01 March 2022

Accepted Manuscript online:
01 March 2022

Article published online:
27 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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