Original ArticlePreliminary report of the 13C-mixed triglyceride breath test to assess timing of pancreatic enzyme replacement therapy in children with cystic fibrosis

BackgroundDespite guidelines suggesting pancreatic enzyme replacement therapy (PERT) should be taken before or during a meal, it is currently unknown whether this has benefits over administration after a meal in individuals with cystic fibrosis (CF).Methods18 children with pancreatic insufficient CF were randomised to two 13C-mixed triglyceride (13C-MTG) breath tests to assess lipase activity with PERT administered 10 min before and 10 min after a meal. Results were expressed as percentage cumulative dose recovered (PCDR) of 13CO2 and were compared with established values in healthy subjects. Gastric half emptying time (T½) was also assessed by a 13C-octanoate breath test.ResultsThere was no difference in mean PCDR of 13CO2 between taking PERT before versus after the meal (p = 0.68). Eleven subjects had a greater PCDR when PERT was taken before and 7 when PERT was taken after the meal. 6/8 subjects (75%) with a lower than normal PCDR at one time point normalised PCDR when PERT timing was changed. When PERT was taken after the meal, PCDR was higher in normal vs. fast T½ (p = 0.04).ConclusionsChanging PERT timing can result in normalised lipase activity. Gastric emptying rate may influence optimal timing of PERT.Clinical Trial Registration Number - This study was undertaken prior to the registration process being a commonly required practice.