Follow-up of coeliac disease with the novel one-hour ¹³C-sorbitol breath test versus the H₂-sorbitol breath test

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 100 mg ¹³C-sorbitol were dissolved in 250 ml 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 in follow-up of coeliac disease.

Key Words::

• Breath test
• carbon isotopes
• coeliac disease
• malabsorption
• sorbitol

Acknowledgements

Kari Tveito was supported by a grant from Eastern Norway Regional Health Authority.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.