Abstract
BackgroundPancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. However, there is no method for assessing PEI that can be used noninvasively and easily for outpatient. It has been reported that changes in intestinal bacteria caused by PEI may increase breath hydrogen concentration (BHC) levels during glucose or lactose loading. We have evaluated the usefulness of fasting breath hydrogen concentration (FBHC) measurement without glucose loading for the evaluation of PEI.MethodsSixty patients underwent FBHC measurement, BT-PABA testing, and microbiome analysis. They were classified into PEI group (PABA excretion rate < 73.4%, n = 30) and non-PEI group (n = 30). The FBHC of the two groups were compared, and the diagnostic ability of PEI by them was evaluated. The 16 s rRNA (V3–V4) from fecal samples was analyzed by MiSeq.ResultsFBHC levels was higher in the PEI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001). FBHC was negatively correlated with PABA excretion rate (r = − 0.523, P < 0.001). The cutoff value of FBHC of 10.7 ppm (95% CI: 0.678–0.913, P < 0.001) showed a sensitivity of 73.3% and specificity of 83.3% for PEI diagnosis. In the PEI group, there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05).ConclusionFBHC shows good potential as a simple and repeatable test for the diagnosis of PEI. The elevated FBHC levels may be caused by hydrogen-producing bacteria such as Clostridium.
Highlights
Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease
The breath hydrogen test (BHT) for pancreatic disease was first examined in the 1960s, and this test is mainly utilized as an indirect diagnostic method for small intestinal bacterial overgrowth syndrome (SIBO), which complicates some chronic pancreatitis (CP) cases [6]
We have found a significant increase in fasting breath hydrogen concentration (FBHC) in patients with pancreatic duct stenosis, which suggests that a decline in exocrine pancreatic secretion induces changes in intestinal bacterial flora [11]
Summary
Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. The breath hydrogen test (BHT) for pancreatic disease was first examined in the 1960s, and this test is mainly utilized as an indirect diagnostic method for small intestinal bacterial overgrowth syndrome (SIBO), which complicates some CP cases [6]. A study in a small number of patients suggested a relationship between PEI and SIBO [7], but the test requires measurement of breath hydrogen continuously for about 2–4 h in a fasting state after glucose loading [8, 9]. Patients with a high fasting breath hydrogen concentration (FBHC) were excluded in many studies [10] and there is no consensus on the relationship between FBHC and pancreatic disease [8, 9]
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