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October28,2014
PHILIDELPHIAChildrenwithirritablebowelsyndromehaveauniquebreathprintthatcouldeventuallybeusedto
diagnosethesyndromesimply,cheaply,andnoninvasively,preliminaryfindingssuggest.
Thereweresignificantlymorebiomarkersofbacterialfermentationandoxidativestressfromvolatileorganiccompounds
inthebreathofpediatricirritablebowelpatientsthaninhealthycontrolsubjects,reportedleadinvestigatorSophiaPatel,
MD,agastroenterologyfellowattheClevelandClinicChildren'sHospital.
"Irritablebowelsyndromeisatoughdiagnosisinpediatricsbecauseitinvolvesalotofinvasiveendoscopicand
radiologictesting.Itwouldbereallyniceifwecoulddoasingletestandsayforcertainwhetherthepatienthasirritable
bowelsyndromeornot,"DrPateltoldMedscapeMedicalNews.
ThestudyresultswerepresentedhereattheAmericanCollegeofGastroenterology2014AnnualScientificMeeting.
"Onepercentofthehumanbreathcontainsvolatileorganiccompounds,whichreflectthemetabolicstateofthebody,"
DrPatelexplained."Ourhopeisthat,inthefuture,asimplebreathsamplecoulddiagnoseirritablebowelsyndromewith
goodaccuracy."
Inpreviousresearch,investigatorsfromtheClevelandClinicChildren'sHospitalfoundthatorganiccompoundsdifferin
childrenwithandwithoutfattyliverdisease.DrPatelandcolleagueshypothesizedthatthesamewouldholdtruefor
irritablebowelsyndrome.
Theyevaluated22childrenwithirritablebowelsyndromeand55healthycontrolsubjects.Meanagewasabout12
years.TheirritablebowelsyndromechildrenwerediagnosedwiththeROMEIIIcriteria,andthehealthychildrenwere
recruitedduringwellchildvisits.
Thereweremoregirlsintheirritablebowelgroupthaninthecontrolgroup(68%vs44%),andbodymassindexwas
higherintheirritablebowelgroup.
"Breathcollectionisaverysimpleprocess,"DrPatelsaid.Subjectsrinsetheirmouthwithwatertohelpdecreasethe
endogenousorganiccompoundsfoundinmouthflora,andtheninhalethroughafilterandexhaleintoasmallbag.
Samplesareanalyzedwithmassspectrometrywithin4hoursofcollection.
"Thefilteralsohelpseliminatesomeoftheexogenouscompoundsthatarecollected,"DrPatelexplained.
Thefourcompoundssignificantlyhigherintheirritablebowelgroupthanintheplacebogroupweredimethylsulfide(a
biomarkerofbacterialfermentation),1octene,3methylhexane,andbenzene(anexogenouscomposite).
Table:ComparisonofBreathCompoundsBetweenPediatricGroups
Compound IrritableBowelGroup(ppb) PlaceboGroup(ppb) PValue
Dimethylsulfide 3.2 1.3 <.01
1octene 10.3 5.9 <.026
3methylhexane 33.3 16.4 <.015
Benzene 2.9 1.9 <.02
ChildrenWithIrritableBowelHaveUniqueBreathprint
PamHarrison
30/10/2014 www.medscape.com/viewarticle/833996_print
http://www.medscape.com/viewarticle/833996_print 2/2

"Wealsodidaperformancediscriminateanalysis,"DrPatelnoted.Usingmassscanningionpeaks,allbut3patients
wereclassifiedintothecorrectgroup.
Furtheranalysisrevealedthatthespecificityandsensitivityofthefourcompoundsareverygood,suggestingthatthey
aregoodmarkersforirritablebowelsyndrome.
"We'venowexpandedthestudytoinclude40to50patientswithirritablebowelsyndrometogetamorecompletelook
atthetwogroups,"shereported."Withahigherpoweredstudy,wemaybeabletodelineatebetweendifferenttypesof
irritablebowelsyndromeandtogeneralizeourfindingstoagreaterpopulation.Sowe'rereallyexcitedaboutthetest."
Thefindingsarestillveryearly,saidBrianLacy,MD,fromtheGeiselSchoolofMedicine,DartmouthHitchcockMedical
Center,inLebanon,NewHampshire.
"Theyarealsoinchildrenandadolescents,sotheymaynotbeapplicabletoadults,"hetoldMedscapeMedicalNews.
Investigatorsalsoneedtocomparetheseparticularcompoundswithahydrogenbreathtest,whichiswidelyusedto
explorethepathophysiologyoffunctionalgastrointestinaldisorders,suchasirritablebowelsyndrome.
"Still,it'sfascinatingearlyworkthatmaylendsomenewinsightintothepathophysiologyofirritablebowelsyndrome,"Dr
Lacysaid."Thenwewillhavetodetermineifthiswilltranslateintoachangeintreatmentorabetterdiagnosis.It'sa
brandnewwayofthinkingaboutirritablebowelsyndrome,whichhiskindofneat."
DrPatelandDrLacyhavedisclosednorelevantfinancialrelationships.
AmericanCollegeofGastroenterology(ACG)2014AnnualScientificMeeting:Abstract12.PresentedOctober20,2014.
MedscapeMedicalNews2014WebMD,LLC
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Citethisarticle:ChildrenWithIrritableBowelHaveUniqueBreathprint.Medscape.Oct28,2014.