triolein and Intestinal-Diseases

The absorption of 14C triolein in a standard fat meal was measured in 60 controls and 66 patients with gastrointestinal disorders by 14CO2 breath sampling. A reference range based upon cumulative eight hour values of the controls was independent of height, weight, and sex. The range was of log normal distribution and declined with age (p less than 0.05). Acceptable 'within-day' and 'between-day' reproducibility was found. All patients tested with untreated coeliac disease, pancreatic insufficiency and most with symptomatic small intestinal Crohn's disease had subnormal values. Twenty per cent of those with irritable bowel syndrome had subnormal values. Patients with ulcerative colitis were all normal. The reagents used and the breath samples after collection were stable. In our experience the 14C triolein test is simple, inexpensive, and helpful in the detection of diseases associated with fat malabsorption. It is of value in monitoring the response to treatment of individual patients with coeliac disease.

Topics: Adolescent; Adult; Age Factors; Aged; Breath Tests; Carbon Radioisotopes; Exocrine Pancreatic Insufficiency; Female; Humans; Intestinal Diseases; Male; Middle Aged; Triolein

In 125 consecutive patients the measurement of serum radioactivities after simultaneous ingestion of 14C-triolein and 3H-oleic acid was investigated as a test of lipid assimilation. The sum of the 2-h and 4-h concentrations of 14C in serum (se(2 + 4)14C) was most useful as an index of lipid assimilation, and the 2-h serum 3H/14C ratio (se-3H/14C) reflected lipid digestion. Normal values were se(2 + 4)14C greater than or equal to 1.0% of the dose ingested per litre serum and se-3H/14C less than 1.3. Se(2 + 4)14C correlated significantly with faecal fat (r = -0.56, P less than 0.001) and indicated malassimilation in 26 of the 50 patients with a faecal fat excretion greater than 7 g/day. False-negative values appeared mainly in the patients with moderate steatorrhoea and gastrointestinal anastomoses. Only one false-positive se(2 + 4)14C value was found. Se-3H/14C was abnormal in 24 of the 34 patients with maldigestion with 2 false-positive results. When the results of se(2 + 4)14C and se-3H/14C were combined, the predictive value of the test result 'normal lipid assimilation' was 0.75, that of the test result 'maldigestion' was 0.93, and that of 'malabsorption' was 0.71. It is concluded that the serum 14C-triolein/3H-oleic acid assimilation test is convenient and inexpensive and may be useful when quantitative faecal collections are not available.

Topics: Adult; Aged; Diagnosis, Differential; Digestion; Female; Food; Humans; Intestinal Diseases; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Oleic Acid; Oleic Acids; Radioisotopes; Triolein

A 14C-triolein breath test was carried out on 49 subjects suffering from chronic pancreatitis or from other digestive diseases, and its results were compared with the daily fecal fat excretion. The 14CO2 peak excretion was abnormal in all the subjects with a fecal fat excretion above 14 g/day, whereas individual values of 14CO2 peak excretion in subjects without steatorrhea and with a fecal fat excretion ranging from 7.1 to 14 g overlapped. The lowest value observed in patients not suffering from steatorrhea was chosen as the lower normal limit of 14CO2 peak excretion. A test sensitivity as high as 64% was attained. The correlation between fecal fat and 14CO2 peak excretion was highly significant (r = 0.802; p less than 0.0001), and it followed a negative exponential function. Therefore, small variations in the 14CO2 peak excretion can be associated with a wide range of fecal fat excretion. Well-compensated diabetes secondary to pancreatitis did not interfere with the results of the test. In conclusion, in our experience this test proved to be a qualitative diagnostic tool with a low sensitivity.

Topics: Adolescent; Adult; Breath Tests; Celiac Disease; Chronic Disease; Feces; Female; Humans; Intestinal Absorption; Intestinal Diseases; Lipid Metabolism; Male; Middle Aged; Pancreatitis; Triolein

Three substrates labeled with nonradioactive 13C have been employed to establish a trilogy of noninvasive breath tests to detect fat malabsorption in children and then to differentiate the etiology of the steatorrhea. Administration of 17 mg/kg of (13C)triolein Lipomul (The Upjohn Co., Kalamazoo, Mich.) resulted in a peak excretion rate of 13CO2 greater than 2.7% dose/h in 10 normal subjects (mean value 4.96 +/- 2.2% dose/h) whereas all 17 subjects with fat malabsorption were below this value (mean value, 0.75% +/- 0.63% dose/h); p less than 0.001). For the detection of fat malabsorption, the discriminative value of (13C)triolein was superior, 100% sensitive, and 89% specific, while the use of (13C)palmitic acid (17 mg/kg) or (13C)trioctanoin (7.5 mg/kg) alone yielded both false-positive and false-negative results. In 6 out of 6 cases, pancreatic insufficiency could be differentiated from mucosal disease (7 patients) or bile salt deficiency (4 patients) by the presence of abnormal triolein or trioctanoin breath tests, or both but normal palmitic acid breath tests. However, further differentiation of mucosal disorders from bile salt disorders could not be achieved using either a single- or a multiple-substrate breath test. The use of the single triolein breath test in children offers an attractive, sensitive alternative to conventional fecal fat measurements to establish the presence of steatorrhea, and when using 12C-lipid with multiple substrates, the tests are capable of providing additional insight into the mechanism of fat malabsorption.

Topics: Adolescent; Biliary Tract Diseases; Breath Tests; Caprylates; Carbon Isotopes; Celiac Disease; Child; Child, Preschool; Exocrine Pancreatic Insufficiency; Humans; Infant; Intestinal Diseases; Palmitic Acid; Palmitic Acids; Triglycerides; Triolein

A direct test of lipid absorption has been developed using [3H]glycerol triether as a lipid marker and [14C]glycerol trioleate as the test lipid. Percentage absorption of triolein is calculated from the isotope ratio ingested and excreted in faeces. The test is independent of a complete faecal collection, reproducible and shows little day to day variation. Absorption in 25 normal subjects ranged from 96.4--100% (mean 98.6, S.D. +/- 1.15). In 24 patients with known pancreatic or small intestinal disease and steatorrhoea absorption ranged from 0.01% to 89.9%. The test has also been assessed by comparison with a standard Lundh test and faecal fat estimation in 34 patients.

Topics: Adult; Aged; Carbon Radioisotopes; Celiac Disease; Fats; Feces; Female; Glycerol; Humans; Intestinal Absorption; Intestinal Diseases; Male; Middle Aged; Pancreatic Diseases; Triolein; Tritium

Topics: Carbon Isotopes; Chronic Disease; Enteritis; Feces; Gastrectomy; Humans; Intestinal Diseases; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Methionine; Oleic Acids; Protein-Losing Enteropathies; Proteins; Serum Albumin, Radio-Iodinated; Stearic Acids; Triolein

Topics: Digestion; Humans; Intestinal Diseases; Iodine Isotopes; Lactose; Lipids; Malabsorption Syndromes; Oleic Acids; Proteins; Serum Albumin, Radio-Iodinated; Triolein; Vitamin B 12; Xylose

Topics: Animals; Carbon; Female; Glucose; Intestinal Diseases; Ischemia; Kidney; Liver; Lung; Macrophages; Mononuclear Phagocyte System; Organ Size; Phagocytosis; Pulmonary Edema; Rats; Shock; Shock, Septic; Spleen; Surface-Active Agents; Triolein

Topics: Bile Acids and Salts; Blood Chemical Analysis; Celiac Disease; Cholecystokinin; Feces; Gastrectomy; Gastrointestinal Hormones; Intestinal Absorption; Intestinal Diseases; Iodine Isotopes; Lipid Metabolism; Pancreatectomy; Pancreatic Juice; Pancreatitis; Pharmacology; Physiology; Salts; Sprue, Tropical; Triolein

Topics: Aged; Aortography; Blood; Blood Vessel Prosthesis; Carotenoids; Celiac Artery; Fats; Feces; Female; Humans; Intestinal Absorption; Intestinal Diseases; Malabsorption Syndromes; Mesenteric Vascular Occlusion; Triolein; Xylose

Topics: Arteriosclerosis; Diarrhea; Edema; Emaciation; Geriatrics; Glucose Tolerance Test; Humans; Ileum; Intestinal Diseases; Intestine, Small; Jejunum; Malabsorption Syndromes; Mesenteric Vascular Occlusion; Oleic Acid; Pathology; Radiography; Triolein; Ulcer; Xylose

This paper discusses the type of results given by a group of test procedures used in the study of small intestinal dysfunction. While the chemical estimation of faecal fat remains the most valuable criterion for the laboratory detection of malabsorption, the occurrence of abnormal faecal or blood radioactivity also denotes the presence of malabsorption, although some patients with staetorrhoea appear to ;absorb' labelled triolein normally. Analysis of data from the other tests shows that steatorrhoea is not necessarily present in patients who give abnormal results and that the presence of malabsorption does not preclude a normal capacity for handling the test substances. These reservations impair the value of the vitamin A and xylose ;tolerance' tests and serum carotene levels as screening procedures for the determination of malabsorption states. On the other hand, these tests show patterns of results which are useful in differentiating idiopathic from secondary steatorrhoea, since patients with secondary malabsorption often handle one or more of these test substances normally.

Topics: Body Fluids; Celiac Disease; Clinical Laboratory Techniques; Feces; Humans; Intestinal Diseases; Intestine, Small; Iodine Isotopes; Statistics as Topic; Triolein; Vitamin A; Xylose

Vitamin A acetate and vitamin A alcohol, triolein I(131), oleic acid I(131), and fat balance tests have been assessed in studies on cases of coeliac disease, pancreatic insufficiency, and some disorders of the small intestinal wall. In coeliac disease a very low serum carotene and flat vitamin A absorption curves have been noted. The contrast between vitamin A acetate and alcohol curves has been clearly shown in cases of pancreatic disorder showing maldigestion. The correlation between vitamin A and triolein I(131) absorption (0.89) is closer than that between vitamin A and fat balance. In assessing intestinal absorption serum carotene figures are of value only if very low figures are found.

Topics: Alcohols; Celiac Disease; Disease; Diterpenes; Fats, Unsaturated; Humans; Intestinal Diseases; Intestine, Small; Intestines; Lipid Metabolism; Oleic Acid; Pancreas; Pancreatic Diseases; Retinyl Esters; Triolein; Vitamin A

Topics: Celiac Disease; Fats; Feces; Humans; Intestinal Diseases; Intestine, Small; Intestines; Oleic Acid; Sprue, Tropical; Triolein