LIPID DIGESTION IN CYSTIC-FIBROSIS - COMPARISON OF CONVENTIONAL AND HIGH-LIPASE ENZYME THERAPY USING THE MIXED-TRIGLYCERIDE BREATH TEST

Background: Fat maldigestion occurs in most patients with cystic fibro sis. Conventional pancreatic enzyme replacement therapy partially corr ects this defect. In this study, the mixed-triglyceride breath test wa s used to evaluate whether high-lipase enzymes are equivalent to conve ntional enzymes in improving fat maldigestion in children with cystic fibrosis. Methods: Fat digestion was studied in 11 patients with a mea n age of 10.5 years. The mean intake of conventional enzyme capsules a day was 19. Four C-13 mixed-triglyceride tests were performed on sepa rate days and in random order. One test was taken without enzyme subst itution, one with three capsules of 8,000 FIP units Creon (pancreatinu m, Kali-chemie Pharma, Hannover, Germany) and one with one capsule of 25,000 FLP units. The fourth test was made with C-13 octanoic acid to study gastric emptying time. Results: Without enzyme intake, the mean cumulative percentage of C-13 dose exhaled after 6 hours was 7.2 +/- 3 .7%. This increased to 14.4 +/- 4% with intake of conventional pancrea tinum and to 14.3 +/- 5.1% with intake of high-lipase pancreatinum (p = 0.0008 for both; paired t-test). There was no difference between bot h treatments. Also, the time course of C-13 exhalation measured by per centage of (CO2)-C-13 exhaled per hour did not differ between enzyme t reatments. Conclusions: The C-13 mixed-triglyceride test is noninvasiv e and documents improved lipid digestion with pancreatic enzyme replac ement therapy. If the lipase dose is kept constant, results obtained w ith high-lipase preparations are equivalent to those obtained with con ventional preparations. (C) 1998 Lippincott-Raven Publishers.