The cholesteryl-14C-octanoate breath test was used to monitor the intraluminal enzymatic activity of
pancreatin preparations in six patients with severe
pancreatic insufficiency. Conventional
enzyme replacement, with
cimetidine as an adjunct, was compared to supplementation with enteric coated
microspheres. In healthy control subjects, 14CO2 excretion rose rapidly and peaked at 90-120 minutes; mean (SD) cumulative recovery at four hours was 51 (8)%. In patients with
pancreatic insufficiency on no treatment mean (SD) cumulative recovery was only 6 (4)%. After
pancreatin, with previous administration of
cimetidine, it increased to 27 (11)% with a time course resembling that in controls. With 2 mm enteric coated
microspheres, 14CO2 excretion did not rise significantly before 120 minutes and cumulative recovery after four hours was 15 (11)%. In a control study, 2 mm
radio-opaque microspheres did not empty from the stomach until two hours after ingestion. The results suggest that the
cholesteryl octanoate breath test can be successfully used to monitor the intraluminal enzymatic activity
after treatment with different forms of
enzyme replacement in
pancreatic insufficiency. In contrast to treatment with conventional
pancreatin and
cimetidine as an adjunct, 2 mm enteric coated
microspheres did not show in vivo enzymatic activity until two hours after administration.