Published online July 5, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 620-626 (doi:10.1542/peds.2008-2257)
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ARTICLE

13C-Sucrose Breath Test: Novel Use of a Noninvasive Biomarker of Environmental Gut Health

Brett K. Ritchie, MBBS, FRACPa, David R. Brewster, MD, FRACP, PhDb, Geoffrey P. Davidson, MBBS, MD, FRACPc, Cuong D. Tran, PhDc,d, Yvette McNeil, PhDe, Joanna S. Hawkes, PhDc and Ross N. Butler, PhDc,d

a Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
b Paediatric Department, James Cook University School of Medicine, Cairns Base Hospital, Cairns, Queensland, Australia
c Gastroenterology Unit, Children, Youth, and Women's Health Service, North Adelaide, South Australia, Australia
d Discipline of Physiology, School of Molecular and Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia
e Environments, Services, and Populations Research Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia

OBJECTIVE: Environmental enteropathy syndrome may compromise growth and predispose to infectious diseases in children in the developing world, including Australian Aboriginal children from remote communities of the Northern Territory. In this study, we described the use of a biomarker 13C-sucrose breath test (SBT) to measure enterocyte sucrase activity as a marker of small intestinal villus integrity and function.

METHODS: This was a hospital-based prospective case-control study of Aboriginal and non-Aboriginal children with and without acute diarrheal disease. Using the SBT, we compared 36 Aboriginal case subjects admitted to a hospital (18 diarrheal and 18 nondiarrheal disease), with 7 healthy non-Aboriginal control subjects. Intestinal permeability using the lactulose/rhamnose (L/R) ratio on a timed 90-minute blood test was performed simultaneously with the SBT. The SBT results are expressed as a cumulative percentage of the dose recovered at 90 minutes.

RESULTS: Aboriginal children with acute diarrheal disease have a significantly decreased absorptive capacity, as determined by the SBT, with a mean of 1.9% compared with either Aboriginal children without diarrhea (4.1%) or non-Aboriginal (6.1%) control subjects. The mean L/R ratio in the diarrhea group was 31.8 compared with 11.4 in Aboriginal children without diarrhea. There was a significant inverse correlation between the SBT and the L/R ratio.

CONCLUSIONS: The SBT was able to discriminate among Aboriginal children with diarrhea, asymptomatic Aboriginal children with an underlying environmental enteropathy, and healthy non-Aboriginal controls. This test provides a noninvasive, easy-to-use, integrated marker of the absorptive capacity and integrity of the small intestine and could be a valuable tool in evaluating the efficacy of interventions aimed at improving gut health.

Key Words: environmental enteropathy • tropical enteropathy • tropic sprue • gut function • sucrose breath test • Australian Aborigines • intestinal permeability

Abbreviations: SBT—13C-sucrose breath test • L/R—lactulose/rhamnose • RDH—Royal Darwin Hospital • WCH—Women's and Children's Hospital • MCV—mean corpuscular volume • cPDR90—cumulative percentage of dose recovered at 90 minutes • CI—confidence interval

Accepted Nov 21, 2008.


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