A Stable Isotope Breath Test With a Standard Meal for Abnormal Gastric Emptying of Solids in the Clinic and in Research
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Background & aims The aim of this study was to validate a [13C]-Spirulina platensis gastric emptying (GE) breath test (GEBT) with a standardized meal. Methods Thirty-eight healthy volunteers and 129 patients with clinically suspected delayed GE underwent measurements at 45, 90, 120, 150, 180, and 240 minutes after a 238 kcal meal labeled test with 100 mg [13C]-S platensis and 0.5 mCi 99mTc. We established normal ranges for scintigraphy with this test meal, intraindividual and interindividual coefficients of variation (COVs), and the ability of the [13C] GEBT breath percent dose excreted *1000 values to predict scintigraphic half-life and to categorize GE as delayed, normal, or accelerated. Results In health, the 10th and 90th percentiles of half-life for scintigraphic GE with this meal were 52 and 86 minutes; intraindividual COVs for scintigraphy and the GEBT were, respectively, 31% and 27% at 45 minutes, 17% and 21% at 90 minutes, 13% and 16% at 120 minutes, 10% and 13% at 150 minutes, and 8% and 12% at 180 minutes. Interindividual COVs at each time for the [13C] GEBT and scintigraphy were typically approximately 1%-4% lower than intraindividual COVs. Individual breath samples at 45, 150, and 180 minutes predicted GE category; at 80% specificity, 45- and 180-minute samples combined were 93% sensitive to identify accelerated GE, and 150- and 180-minute combined were 89% sensitive for delayed GE. Conclusions [13C]-S platensis GEBT is as reproducible as scintigraphy; imprecision with both tests reflects physiologic variation. With 4 breath samples, this method with an off-the-shelf meal is valid to assess GE in clinic and in research.
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Results of the 13C breath test can be influenced by extra gastric factors such as liver function, pulmonary disease, and small-intestinal absorption kinetics.
“However, results can be influenced by extra gastric factors such as liver function, pulmonary disease, and small-intestinal absorption kinetics [3, 14, 66, 69, 70].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [69]
The Substrate section says the label must be digested, absorbed, and metabolized before it appears in breath CO₂. The Discussion says participants with clinically apparent malabsorption or significant liver disease were excluded. These passages support a role for processes beyond gastric emptying, but the paper does not identify pulmonary disease as an influence or quantify how the listed factors affect results. Page numbers were not provided in our copy. (LLM, conf=0.82)
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References 24 · Cited by 209
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- Authors
- Szarka, L. A., Camilleri, M., Vella, A., Burton, D., Baxter, K., Simonson, J., & Zinsmeister, A. R.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Szarka, Lawrence A.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2008-06
- Volume
- 6
- Issue
- 6
- Pages
- 635-643.e1
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC3739971
- OpenAlex
- W2165046753
- Cited by
- 209
- References
- 24
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 10 · 2023: 11 · 2022: 15 · 2021: 20 · 2020: 19 · 2019: 17 · 2018: 8 · 2017: 10 · 2016: 15 · 2015: 11 · 2014: 13 · 2013: 9 · 2012: 9
- FWCI
- 6.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK02638, K24DK002638, R01DK067071, R01DK078646, R01-DK67071)
- National Center for Research Resources (RR-024150, UL1RR024150)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- gastric emptying, scintigraphy, test reproducibility, delayed gastric emptying, test validation, technetium-99m
- MeSH terms
- Adolescent, Adult, Aged, Analysis of Variance, Breath Tests, Carbon Isotopes, Female, Gastric Emptying, Half-Life, Humans, Male, Middle Aged, Radionuclide Imaging, Sensitivity and Specificity, Stomach Diseases, Technetium, Time Factors, Area Under Curve, Spirulina
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