The concept of 13C breath testing is based on measuring the ratios of two non-radioactive isotopes of the Carbon atom in the form of CO2: Carbon 12 (12C) and Carbon 13 (13C). Both of the two isotopes naturally exist in normal breath but with different ratios. Approximately 99% of exhaled breath is 12C, and approximately 1% is isotope 13C.
Breath testing is based on changing this ratio by giving the patient a substrate which is metabolized by a target organ. After ingestion, its measurable metabolite is expelled by the respiratory system and measured by the BreathID System. The exhalation of 13CO2 in a patient's breath over a period of time will determine the target organ’s health.
Despite the non-invasiveness of a breath test, only the 13C-urea breath test for diagnosing H. pylori has been accepted for routine clinical use. Other possible future 13C tests currently under investigational use include:
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Assessment of liver impairment: Liver impairment is currently assessed mainly by standard serologic and biochemical liver tests, which do not provide an accurate assessment of hepatic functional capacity. Today, liver impairment is tested by standard serologic and biochemical serum liver tests, which do not provide an accurate assessment of liver function capacity and are relatively inaccurate in detecting hepatic disease severity. Different substrates such as 13C-methacetin, 13C-aminopyrine and 13C-L-phenylalanine and others have been used for this purpose. For more information on liver impairment, go to the Exalenz Bioscience website.
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Assessment of disease severity in fatty liver disease: Imaging may be used in order to assess fat accumulation in the liver, but it is limited in its ability to assess and manage fatty liver disease progress. Liver biopsies may be performed, but they have added risks of complications. The 13C-sodium octanoate breath test has been used to assess liver mitochondrial beta oxidation, which may be a reliable indication of disease severity.
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Assessment of gastroparesis (delayed gastric emptying): Breath testing using the 13C-octanoic acid (solid meal) and 13C-sodium acetate substrates can be used to determine gastroparesis, a disorder in which the stomach empties its contents slowly due to impaired gastric motor function.
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Assessment of exocrine pancreatic function: While direct pancreatic function tests such as the secretin test, can be used to assess exocrine pancreatic function, they are rarely used since they are invasive, expensive and extremely cumbersome. Literature has demonstrated that the use of 13C-labeled lipids breath test substrates (trioctanoin, triolein, and palmitic acid), provide a practical alternative to direct exocrine pancreas function assessment.
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Other Tests include: Assessment of bacterial overgrowth, B12 deficiency, gastric accommodation and others.
For more information about how the BreathID breath test system is used to detect H. pylori at the point-of-care, please watch a short film on Urea Breath Tests or contact a company representative by completing the contact form.