Lipid Digestion in Cystic Fibrosis: Comparison of Conventional and High‐Lipase Enzyme Therapy Using the Mixed‐Triglyceride Breath Test

ABSTRACT Background: Fat maldigestion occurs in most patients with cystic fibrosis. Conventional pancreatic enzyme replacement therapy partially corrects this defect. In this study, the mixed‐triglyceride breath test was used to evaluate whether high‐lipase enzymes are equivalent to conventional enzymes in improving fat maldigestion in children with cystic fibrosis. Methods: Fat digestion was studied in 11 patients with a mean age of 10.5 years. The mean intake of conventional enzyme capsules a day was 19. Four 13 C mixed‐triglyceride tests were performed on separate days and in random order. One test was taken without enzyme substitution, one with three capsules of 8,000 FIP units Creon (pancreatinum, Kali‐chemie Pharma, Hannover, Germany) and one with one capsule of 25,000 FIP units. The fourth test was made with 13 C octanoic acid to study gastric emptying time. Results: Without enzyme intake, the mean cumulative percentage of 13 C dose exhaled after 6 hours was 7.2 ± 3.7%. This increased to 14.4 ± 4% with intake of conventional pancreatinum and to 14.3 ± 5.1% with intake of high‐lipase pancreatinum ( p = 0.0008 for both; paired t ‐test). There was no difference between both treatments. Also, the time course of 13 C exhalation measured by percentage of 13 CO 2 exhaled per hour did not differ between enzyme treatments. Conclusions: The 13 C mixed‐triglyceride test is noninvasive and documents improved lipid digestion with pancreatic enzyme replacement therapy. If the lipase dose is kept constant, results obtained with high‐lipase preparations are equivalent to those obtained with conventional preparations.