Follow-up of coeliac disease.pdf

Scandinavian Journal of Gastroenterology, 2011; 46: 837–843 ORIGINAL ARTICLE Follow-up of coeliac disease with the novel one-hour 13C-sorbitol breath test versus the H2-sorbitol breath test KARI TVEITO1, ANNE KRISTINE HETTA2, MIA ASKEDAL1, CATHRINE BRUNBORG3, LEIV SANDVIK3, ELSE MARIT L?BERG4 VIGGO SKAR1 1Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway, 2Department of Medicine, Stavanger University Hospital, Stavanger, Norway, 3Unit for epidemiology and biostatistics, Oslo University Hospital - Ullevaal, Oslo, Norway, and 4Department of Pathology, Oslo University Hospital-Ullevaal, Oslo, Norway Abstract Background.We recently developed a 13C-sorbitol breath test (13C-SBT) as an alternative to the H2-sorbitol breath test (H2- SBT) for coeliac disease. In this study we compared the diagnostic properties of the H2-SBT and the 13C-SBT in follow-up of coeliac disease. Material and methods. Twenty-seven coeliac patients on a gluten-free diet (GFD) performed the breath tests. All had been tested before treatment in the initial study of the 13C-SBT, in which 39 untreated coeliac patients, 40 patient controls, and 26 healthy volunteers participated. Five gram sorbitol and 100mg 13C-sorbitol were dissolved in 250ml tap water and given orally. H2, CH4 and 13CO2 were measured in end-expiratory breath samples every 30 min for 4 h. Increased H2 concentration ?20 ppm from basal values was used as cut-off for the H2-SBT. Sixty minutes values were used as diagnostic index in the 13C-SBT. Results. 13CO2 levels at 60 min increased in 20/26 treated coeliac patients (77%) after GFD, but were significantly lower than in control groups. Out of 20 patients who had a positive H2-SBT before GFD, 12 had a negative H2- SBT after GFD. Peak H2 concentrations were not correlated with 13C-SBT results. Conclusion. The study confirms the sensitivity of a one-hour 13C-SBT for small intestinal malabsorption. The 13C-SBT has superior diagnostic properties compared with the H2-SBT