United European Gastroenterol J. 2021 Jun 14. doi: 10.1002/ueg2.12099.Online ahead of print.

Jutta Keller ¹, Heinz F Hammer ², Paul R Afolabi ³, Marc Benninga ⁴, Osvaldo Borrelli ⁵, Enrique Dominguez-Munoz ⁶, Dan Dumitrascu ⁷, Oliver Goetze ⁸, Stephan L Haas ⁹, Bruno Hauser ¹⁰, Daniel Pohl ¹¹, Silvia Salvatore ¹², Marc Sonyi ^2 13, Nikhil Thapar ^5 14, Kristin Verbeke ¹⁵, Mark R Fox ^11 16, European 13C-breath test group

Author information

• ¹Department of Internal Medicine, Israelitic Hospital, Academic Hospital University of Hamburg, Hamburg, Germany.
• ²Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
• ³NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
• ⁴Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
• ⁵UCL Great Ormond Street Institute of Child Health and Department of Gastroenterology, Neurogastroenterology and Motility, Great Ormond Street Hospital, London, UK.
• ⁶Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain.
• ⁷Clinica Medicala 2, Cluj-Napoca, Romania.
• ⁸Department of Medicine II, Division of Hepatology, University Hospital Würzburg, Würzburg, Germany.
• ⁹Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
• ¹⁰Department of Paediatric Gastroenterology, Hepatology and Nutrition, KidZ Health Castle UZ Brussels, Brussels, Belgium.
• ¹¹Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
• ¹²Pediatric Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy.
• ¹³Clinic for General Medicine, Gastroenterology, and Infectious Diseases, Augustinerinnen Hospital, Cologne, Germany.
• ¹⁴Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Australia.
• ¹⁵Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.
• ¹⁶Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.

Abstract

Introduction: ¹³ C-breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers.

Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of ¹³ C-breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed.

Results: The guideline gives an overview over general methodology of ¹³ C-breath testing and provides recommendations for the use of ¹³ C-breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of ¹³ C-breath testing are summarized briefly. The recommendations specifically detail when and how individual ¹³ C-breath tests should be performed including examples for well-established test protocols, patient preparation, and reporting of test results.

Conclusion: This clinical practice guideline should improve pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of ¹³ C-breath tests.