Noninvasive 13C-Octanoic Acid Breath Test Shows Delayed Gastric Emptying in Patients with Amyotrophic Lateral Sclerosis
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive loss of motor neurons. However, ALS has been recognized to also involve non-motor systems. Subclinical involvement of the autonomic system in ALS has been described. The recently developed (13)C-octanoic acid breath test allows the noninvasive measurement of gastric emptying. With this new technique we investigated 18 patients with ALS and 14 healthy volunteers. None of the patients had diabetes mellitus or other disorders known to cause autonomic dysfunction. The participants received a solid standard test meal labeled with (13)C-octanoic acid. Breath samples were taken at 15-min intervals for 5 h and were analyzed for (13)CO(2) by isotope selective nondispersive infrared spectrometry. Gastric emptying peak time (t(peak)) and emptying half time (t(1/2)) were determined. All healthy volunteers displayed normal gastric emptying with a mean emptying t(1/2) of 138 +/- 34 (range 68-172) min. Gastric emptying was delayed (t(1/2) > 160 min) in 15 of 18 patients with ALS. Emptying t(1/2) in ALS patients was 218 +/- 48 (range 126-278) min (p < 0.001). These results are compatible with autonomic involvement in patients with ALS, causing delayed gastric emptying of solids and encouraging the theory that ALS is a multisystem disease rather than a disease of the motor neurons only.
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Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management.
“Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management (Chapin et al., 2020; Elbe et al., 2020; Toepfer et al., 1999; Toepfer et al., 1997).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Toepfer et al., 1999
The Introduction mentions bulbar paresis, but the Discussion says participants swallowed the test meal within normal time limits; the study assesses gastric emptying rather than characterizing swallowing impairment. Searches for dysphagia, early recognition, and multidisciplinary management found no passage addressing those claims. The normal test-meal swallowing result does not contradict the broader claim about ALS. (LLM, conf=0.76)
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- Authors
- Toepfer, M., Folwaczny, C., Lochmüller, H., Schroeder, M., Riepl, R. L., Pongratz, D., & Müller-Felber, W.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- ORCID
- Lochmüller, H.
- Venue
- Digestion
- Publisher
- S. Karger AG
- Published
- 1999
- Volume
- 60
- Issue
- 6
- Pages
- 567-571
- ISSN
- 0012-2823 (ISSN-L)
- 1421-9867
- OpenAlex
- W2039362701
- Cited by
- 53
- References
- 22
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 5 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 2
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Digestion (publishedVersion)
- PubMed (publishedVersion)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- amyotrophic lateral sclerosis, delayed gastric emptying, 13C-octanoic acid breath test, autonomic dysfunction, non-motor symptoms, multisystem disease
- MeSH terms
- Adult, Aged, Amyotrophic Lateral Sclerosis, Autonomic Nervous System Diseases, Breath Tests, Caprylates, Carbon Isotopes, Female, Gastric Emptying, Humans, Male, Middle Aged, Prognosis, Spectrophotometry, Infrared, Stomach, Stomach Diseases
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