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The assessment of liver function using breath tests @Hadassah Medical Center

Reporter: Aviva Lev-Ari, PhD, RN

Unresolved issues of breath testing

Similar to many other diagnostic tests, several issues remain unresolved in breath testing. The first is the role of hypoxia, which may contribute to impaired liver function and interfere with the results of liver function tests. In patients with cirrhosis, cytochrome P‐450‐mediated metabolism is facilitated in the presence of supplemental oxygen. The effect of oxygen supplementation on hepatic microsomal function as assessed by MBT in patients with cirrhosis of different severities and degrees of anaemia has been evaluated.47 In patients who breathe room air, the total amount of ¹³C exhaled is weakly correlated with the CTP score and haemoglobin concentrations. Oxygen supplementation increased the total amount of ¹³C exhaled by 68 ± 90%. Preliminary data suggest that MBT results are independent of the patient’s pulmonary function and can be performed in ventilated patients (G. Lalazar, Hebrew University–Hadassah Medical Center, Jerusalem, unpublished data). The second issue affecting the MBT is that endogenous CO₂ production changes with age, motor activity and nutrition. Recent unpublished data suggest that MBT results are independent of gastrointestinal function. Thirdly, the intra‐hepatic resistance index, as measured by Doppler‐pulsed wave analysis, was increased in elderly subjects, and this index was inversely correlated with the results of the MBT.46 Finally, although several studies have suggested that MBT can distinguish between early cirrhotic (Child A) and non‐cirrhotic patients, the ability of the MBT to detect the early‐stages of fibrosis remains yet unproven.16

Table 1. Clinical situations where assessment of liver reserve with the breath test system may be beneficial

Patients with acute liver disease	Follow‐up of patients with fulminant or subfulminant liver disease to determine the need for liver transplantation or to predict recovery.
Patients with chronic liver disease	Follow‐up and prediction of complications and prognosis in patients with chronic liver disease. A non‐invasive tool for assessment of degree of liver fibrosis. Follow‐up of response to treatment (anti‐virals in chronic hepatitis B and C viruses; steroids in autoimmune hepatitis). Deciding the timing of liver transplantation and prioritizing patients on the waiting list. Assessment of liver reserve in patients with cholestatic liver diseases. Distinguishing non‐alcoholic fatty liver disease from non‐alcoholic steatohepatitis.
Before and after procedures	Assessment of liver reserve before hepatectomy. Assessment of liver reserve in living donors and of brain death donors with marginal livers. Determining liver reserve before insertion of transjugular intrahepatic portosystemic stent shunt. Pre‐ and postchemoembolizations. Follow‐up of graft function after liver transplantation. Determining the liver impairment prior to bariatric surgery or any non‐hepatic major surgery in patients with chronic liver disease.
Screening of healthy population	Screening test for occult liver disease in seemingly healthy populations.

SOURCE

Review article: the assessment of liver function using breath tests

Y. ILAN

First published: 15 September 2007

https://doi.org/10.1111/j.1365-2036.2007.03519.x

Cited by: 36

Prof. Y. Ilan, Hebrew University, Hadassah Medical Center, PO Box 12000, Jerusalem, Israel.
E‐mail: deborah@hadassah.org.il

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2036.2007.03519.x

Patient success story

http://www.hadassah.org/news-stories/grateful-patient-returns-to-thank-hadassah.html