Résumé
Les tests respiratoires au CO2 permettent l’exploration non invasive de différentes fonctions digestives et hépatiques. Le carbone 13 est le principal isotope utilisé comme traceur, du fait de sa non-radioactivité. En France, les molécules marquées au carbone 13 sont considérées comme des médicaments, ce qui limite leur utilisation en pratique courante.
La mesure du13CO2 dans les gaz expirés fait appel à une technique sensible et onéreuse, la spectrométrie de masse isotopique. Des méthodes moins coûteuses sont développées, telles que la spectrométrie infrarouge.
Le test respiratoire au carbone 13 le plus répandu dans le monde est le test respiratoire à l’urée-13C pour le diagnostic de l’infection gastrique àHelicobacter pylori. Ce test a obtenu l’Autorisation de Mise sur le Marché en France, pour le contrôle de l’éradication d’Helicobacter pylori après traitement.
Il est également possible d’étudier la vidange gastrique et le temps de transit intestinal par des tests respiratoires au carbone 13. La recherche d’une intolérance au lactose peut faire appel au test respiratoire au, lactose-13C. Différents tests ont été proposés pour la mesure de la sécrétion exocirne du pancréas. Enfin, les tests respiratoires au carbone 13 constituent une voie d’avenir pour l’évaluation quantitative des multiples voies métaboliques hépatiques.
Summary
CO2 breath tests allow the non invasive exploration of several digestive and hepatic functions. Carbon 13 is the main isotope used as tracer, because it is not radioactive. In France, carbone 13-labeled substrates are classified as drugs, a position that limits their used in clinical practice.
Measurements of13CO2 in breath are performed by a sensitive and costly method, the isotope ratio mass spectrometry. Cheaper techniques such as infrared spectrometry are now available.
The13C-urea breath test is currently the most available worldwide, for the diagnosis of gastricHelicobacter pylori infection. This test has been recently cleared for marketing in France, to control the eradication ofHelicobacter pylori infection.
13CO2 breath tests are also available to study gastric emptying and intestinal transit time. Lactose intolerance can be studied by the13C-lactose breath test. Several breath tests have been developed for the study of exocrine pancreatic function. Finally,13CO2 breath tests may prove useful for the quantitiative evaluation of various hepatic metabolic pathways.
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Mion, F. Place des tests respiratoires au carbone 13 en Exploration Fonctionnelle Digestive. Acta Endosc 30, 237–242 (2000). https://doi.org/10.1007/BF03022114
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DOI: https://doi.org/10.1007/BF03022114