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Fecal 13C analysis for the detection and quantitation of intestinal malabsorption. Limits of detection and application to disorders of intestinal cholylglycine metabolism.

The use of 14CO2 breath tests and fecal analyses for the detection and quantitation of intestinal malabsorption has been extensively documented in adult subjects. The use of stable isotopes has extended the range of breath test applications to include pediatric and obstetric subjects. Here we report a fecal 13C analysis that can be used in conjunction with 13CO2 breath tests. Twenty-four-hour fecal samples were collected before and after the administration of a labeled substrate. The samples were homogenized and combusted to CO2, and the 13C abundance was determined by high-precision, differential isotope ratio mass spectrometry. The isotopic variation between successive 24 hr fecal samples was 0.6 0/00 (0.0006 atom percent). This variation limited the sensitivity of the fecal analysis to 13 mumol of 13C label per mold of fecal carbon. Simultaneous cholyglycine 13CO2 breath tests and fecal assays were performed in five children. One child with bacterial overgrowth had an abnormal breath test and a normal fecal test. Of three children with ileal dysfunction, only one had an abnormal breath test, whereas the fecal test was abnormal in all three, Both the breath test and fecal test were abnormal for a child who had undergone an ileal resection. Both tests were normal for a child with ulcerative colitis.