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The cholyl glycine-1-14C breath test was evaluated in a variety of gastrointestinal disorders. 138 tests were performed in 106 patients. Methods of data expression were evaluated and the cumulative 8-hour value was used. In 27 control patients the upper limit of the normal was found to be 78. A good correlation was found between the peak values and the cumulative 8-hour values (r = 0.95, p less than 0.01). The reproducibility of the test was good (r = 0.985, p less than 0.05). Abnormal results were found in 12 out of 13 cases with resection of the ileum and 11 out of 14 cases with Crohn's disease of the distal small bowel. The test was normal in cases with diseases of the proximal small bowel (celiac, Whipple's and Chron's diseases). The test was also normal in patients with colitis. It was abnormal in some of the cases after cholecystectomy and in most cases with carcinoma of the pancreas. The breath test was useful in monitoring the results of treatment in bacterial overgrowth of the small bowel. False negative results were observed after antibiotic treatment. The method seems to be more sensitive than the Schilling test in diagnosing disease of the distal small bowel.

An attempt was made to evaluate the diagnostic effectiveness of the 14CO2-tripalmitin breath test in the screening or diagnosis of fat malabsorption. The differential absorption of 14C-tripalmitin and palmitic acid was evaluated in the diagnosis of pancreatic insufficiency. 24 controls, 13 patients with steatorrhea and 6 with pancreatic disease (4 of them with sufficiency) were studied. 81 breath tests were performed using 75 ml sour cream as a carrier. In 11 cases the 14C-tripalmitin test was repeated using 27 g corn oil as carrier. Both the 14C-tripalmitin and 14C-palmitic acid breath tests failed to provide any discrimination between normals and patients with fat malabsorption. Variation in type and amount of the carrier fat did not alter these results. 14C-tripalmitin absorption was distinctly abnormal in the patients with pancreatic insufficiency. The differential absorption of 14C-tripalmitin and 14C-palmitic acid provided an even better separation between patients with and without pancreatic disease. In contrast to some other investigators we did not find the 14C-tripalmitin and/or palmitic acid breath tests useful in the diagnosis or screening of fat malabsorption. These tests appear promising in the diagnosis of pancreatic disease.

Sodium dehydrocholate administration significantly impaired bromosulfophthalein (BSP) clearance in six normal volunteers, despite its choleretic effect. In order to determine whether the impairment is at the stage of excretion of BSP from the liver cell into the bile, patients with Dubin-Johnson syndrome were studied. In all six Dubin-Johnson patients, sodium dehydrocholate administration significantly decreased BSP clearance. Since serum bile acid levels are normal in Dubin-Johnson patients, presumably due to a final secretory pathway into the bile distinct from that of BSP and other organic anions, the interaction between BSP and bile acids cannot take place at the stage of excretion into the bile. Based on a previous study and our results, the interaction between BSP and bile salts seems to occur at the site of transport within the liver cell. This mechanism of inhibition may be responsible for the increased serum BSP retention during chemotherapy.