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Chou H, Godbeer L, Allsworth M, Boyle B, Ball ML. Progress and challenges of developing volatile metabolites from exhaled breath as a biomarker platform. Metabolomics 2024; 20:72. [PMID: 38977623 PMCID: PMC11230972 DOI: 10.1007/s11306-024-02142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The multitude of metabolites generated by physiological processes in the body can serve as valuable biomarkers for many clinical purposes. They can provide a window into relevant metabolic pathways for health and disease, as well as be candidate therapeutic targets. A subset of these metabolites generated in the human body are volatile, known as volatile organic compounds (VOCs), which can be detected in exhaled breath. These can diffuse from their point of origin throughout the body into the bloodstream and exchange into the air in the lungs. For this reason, breath VOC analysis has become a focus of biomedical research hoping to translate new useful biomarkers by taking advantage of the non-invasive nature of breath sampling, as well as the rapid rate of collection over short periods of time that can occur. Despite the promise of breath analysis as an additional platform for metabolomic analysis, no VOC breath biomarkers have successfully been implemented into a clinical setting as of the time of this review. AIM OF REVIEW This review aims to summarize the progress made to address the major methodological challenges, including standardization, that have historically limited the translation of breath VOC biomarkers into the clinic. We highlight what steps can be taken to improve these issues within new and ongoing breath research to promote the successful development of the VOCs in breath as a robust source of candidate biomarkers. We also highlight key recent papers across select fields, critically reviewing the progress made in the past few years to advance breath research. KEY SCIENTIFIC CONCEPTS OF REVIEW VOCs are a set of metabolites that can be sampled in exhaled breath to act as advantageous biomarkers in a variety of clinical contexts.
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Mathews SC, Templeton S, Taylor SK, Harris S, Stewart M, Raja SM. Evaluation of a Digital Handheld Hydrogen Breath Monitor to Diagnose Lactose Malabsorption: Interventional Crossover Study. JMIR Form Res 2021; 5:e33009. [PMID: 34544034 PMCID: PMC8561400 DOI: 10.2196/33009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Lactose malabsorption is a common condition that affects a broad segment of the population. Clinical diagnosis based on symptom recall can be unreliable and conventional testing can be inconvenient, requiring expensive laboratory-based equipment and conduction of the testing in a clinical setting. Objective The aim of this study is to assess the performance of a digital handheld hydrogen breath monitor (GIMate) in diagnosing lactose malabsorption compared to a US Food and Drug Administration (FDA)–cleared device (H2 Check) for the same indication. Methods An interventional crossover study was performed in adult participants with a prior confirmed diagnosis of lactose malabsorption or a suspected history of lactose intolerance. Results A total of 31 participants (mean age 33.9 years) were enrolled in the study. There was 100% positive percent agreement and 100% negative percent agreement between the GIMate monitor and the H2 Check. Correlation between gastrointestinal symptoms and hydrogen values was positive at 0.82 (P<.001). Conclusions The digital handheld GIMate breath monitor achieved equivalent diagnostic performance to that of an FDA-cleared device in the diagnosis of lactose malabsorption. Trial Registration ClinicalTrials.gov NCT04754724; https://clinicaltrials.gov/ct2/show/NCT04754724
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Affiliation(s)
| | - Sandy Templeton
- Electronics Program, Penn Foster College, Scottsdale, AZ, United States
| | | | - Sten Harris
- Duke Early Phase Clinical Research Unit, Durham, NC, United States
| | - Margaret Stewart
- Duke Early Phase Clinical Research Unit, Durham, NC, United States
| | - Shruti M Raja
- Duke Early Phase Clinical Research Unit, Durham, NC, United States
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Lee SM, Falconer IHE, Madden T, Laidler PO. Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000640. [PMID: 34168044 PMCID: PMC8231001 DOI: 10.1136/bmjgast-2021-000640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE A high quality end-expiratory breath sample is required for a reliable gastrointestinal breath test result. Oxygen (O2) concentration in the breath sample can be used as a quality marker. This study investigated the characteristics of O2 concentration in the breath sample and the impact of using a correction factor in real-time breath measurement. DESIGN This study includes two separate groups of patient data. Part 1 of the study analysed the patient's ability to deliver end-expiratory breath samples over a 2-year period (n=564). Part 2 of the study analysed a separate group of patients (n=47) with additional data to investigate the O2 characteristics and the role of correction factor in breath test. RESULTS The results indicated 95.4% of 564 patients were able to achieve an O2 concentration below 14% in their end-expiratory breath. Part 2 of the study revealed that the distribution of O2 concentration was between 9.5% and 16.2%. Applying a correction factor to predict the end-expiratory H2 and CH4 values led to an average measurement error of -36.4% and -12.8%, respectively. CONCLUSION The majority of patients are able to deliver a high quality end-expiratory breath sample, regardless of age or gender. The correction factor algorithm is unreliable when predicting the end-expiratory result at 15% O2 and it would have resulted in false negative result for 50% of the positive cases in this study. It has also indicated that the continuous O2 measurement is essential to ensure breath sample quality by preventing secondary breathing during real-time breath collection.
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Affiliation(s)
- Siu Man Lee
- Medical Physics & Bioengineering, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Imogen H E Falconer
- Medical Physics & Bioengineering, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Trudi Madden
- Medical Physics & Bioengineering, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Peter O Laidler
- Medical Physics & Bioengineering, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Silva CDJ, Leite IDS, Rodrigues JW, Almeida SPD, Nóbrega BP, Sampaio Filho JDR. ANALYSIS OF LACTOSE INTOLERANCE IN STUDENTS WITH SUGGESTIVE SYMPTOMS OF IRRITABLE BOWEL SYNDROME. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:304-311. [PMID: 31633730 DOI: 10.1590/s0004-2803.201900000-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.
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Affiliation(s)
- Cleise de Jesus Silva
- Faculdade de Medicina da Universidade Federal Do Vale do São Francisco, Paulo Afonso, BA, Brasil
| | | | - José Weberton Rodrigues
- Faculdade de Medicina da Universidade Federal Do Vale do São Francisco, Paulo Afonso, BA, Brasil
| | | | - Bruna Pessoa Nóbrega
- Faculdade de Medicina da Universidade Federal Do Vale do São Francisco, Paulo Afonso, BA, Brasil
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Shrestha A, Prodhan UK, Mitchell SM, Sharma P, Barnett MPG, Milan AM, Cameron-Smith D. Validity of a Portable Breath Analyser (AIRE) for the Assessment of Lactose Malabsorption. Nutrients 2019; 11:nu11071636. [PMID: 31319625 PMCID: PMC6683064 DOI: 10.3390/nu11071636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022] Open
Abstract
Hydrogen (H2) measurement in exhaled breath is a reliable and non-invasive method to diagnose carbohydrate malabsorption. Currently, breath H2 measurement is typically limited to clinic-based equipment. A portable breath analyser (AIRE, FoodMarble Digestive Health Limited, Dublin, Ireland) is a personalised device marketed for the detection and self-management of food intolerances, including lactose malabsorption (LM). Currently, the validity of this device for breath H2 analysis is unknown. Individuals self-reporting dairy intolerance (six males and six females) undertook a lactose challenge and a further seven individuals (all females) underwent a milk challenge. Breath samples were collected prior to and at frequent intervals post-challenge for up to 5 h with analysis using both the AIRE and a calibrated breath hydrogen analyser (BreathTracker, QuinTron Instrument Company Inc., Milwaukee, WI, USA). A significant positive correlation (p < 0.001, r > 0.8) was demonstrated between AIRE and BreathTracker H2 values, after both lactose and milk challenges, although 26% of the AIRE readings demonstrated the maximum score of 10.0 AU. Based on our data, the cut-off value for LM diagnosis (25 ppm H2) using AIRE is 3.0 AU and it is effective for the identification of a response to lactose-containing foods in individuals experiencing LM, although its upper limit is only 81 ppm.
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Affiliation(s)
- Aahana Shrestha
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- The Riddet Institute, Palmerston North 4442, New Zealand
| | - Utpal K Prodhan
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- The Riddet Institute, Palmerston North 4442, New Zealand
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | - Sarah M Mitchell
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- The Riddet Institute, Palmerston North 4442, New Zealand
| | - Pankaja Sharma
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- The Riddet Institute, Palmerston North 4442, New Zealand
| | - Matthew P G Barnett
- The Riddet Institute, Palmerston North 4442, New Zealand
- Food Nutrition & Health Team, AgResearch Limited, Private Bag 11008, Palmerston North 4442, New Zealand
- The High-Value Nutrition National Science Challenge, Auckland 1023, New Zealand
| | - Amber M Milan
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- The Riddet Institute, Palmerston North 4442, New Zealand
- Food Nutrition & Health Team, AgResearch Limited, Private Bag 11008, Palmerston North 4442, New Zealand
| | - David Cameron-Smith
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand.
- The Riddet Institute, Palmerston North 4442, New Zealand.
- Food & Bio-based Products Group, AgResearch Limited, Private Bag 11008, Palmerston North 4442, New Zealand.
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Impact of regional differences along the gastrointestinal tract of healthy adults on oral drug absorption: An UNGAP review. Eur J Pharm Sci 2019; 134:153-175. [DOI: 10.1016/j.ejps.2019.04.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023]
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Is Hydrogen Breath Test with Lactulose Feasible for Measuring Gastrocecal Transit in Critically Ill Children? Pilot Study about Modification of the Technique. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5878659. [PMID: 28246601 PMCID: PMC5299192 DOI: 10.1155/2017/5878659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/18/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022]
Abstract
Introduction. Gastrocecal transit time (GCTT) can be measured by exhaled hydrogen after lactulose intake (lactulose-eH2 test). The objectives were to assess whether it is possible to carry out this test in critically ill children with and without mechanical ventilation (MV) and to analyze whether the results are consistent with clinical findings. Methods. Patients admitted to the Pediatric Intensive Care Unit (PICU) for more than 3 days were included. Those with gastrointestinal disease prior to admission were excluded. A modified technique to obtain eH2 from the ventilator tubes was performed. Results. Sixteen patients (37.5% boys) with a median age of 19 (5-86.5) months were included. Five patients (31.2%) were breathing spontaneously but lactulose-eH2 test could not be performed while it could be performed successfully in the 11 patients with MV. Seven patients (63.3%) did not show an eH2 peak. The other 4 showed a median time of 130 min (78.7-278.7 min) from lactulose intake to a 10 ppm eH2 peak. Children with an eH2 peak had intestinal movements earlier [6.5 (1.5-38.5) versus 44 (24-72) hours p = 0.545]. Conclusion. Although the designed adaption is useful for collecting breath samples, lactulose-eH2 test may not be useful for measuring GCTT in critically ill children.
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Abstract
GOALS To assess the prevalence of small intestinal bacterial overgrowth (SIBO) in chronic pancreatitis (CP), and analyze factors related with SIBO in CP. BACKGROUND SIBO is to be considered a factor that worsens symptoms and nutritional status in patients with CP. However, the few studies evaluating the rate of SIBO in CP patients used nonuniform and nonstandardized procedures, and reported a wide range of positivity (0% to 92%). Those studies often investigated CP patients with previous resection surgery (cause of SIBO per se). STUDY CP patients and controls evaluated for SIBO by the H2 glucose breath test with a standard protocol. For CP patients, the relationship between test results, abdominal symptoms, and clinical and biochemical variables was analyzed. RESULTS A total of 43 CP patients and 43 controls were enrolled. Of the CP patients, 8 had advanced disease (defined by M-ANNHEIM index) and none had undergone previous surgery. The glucose breath test positivity rate was higher in the CP patients than in the controls (21% vs. 14%), albeit without a significant difference (P=0.57). Mean fasting H2 excretion and mean H2 excretion at 120 minutes also had a trend toward higher levels in CP patients. There were no clinical differences between CP patients with or without SIBO, but there were nutritional differences for lower levels of vitamin D and higher levels of folate in these patients with SIBO. CONCLUSIONS Our findings suggest that SIBO is not uncommon in uncomplicated CP patients. The lack of a significant difference compared with controls might be due to the study being underpowered. SIBO in CP patients does not seem to be related to peculiar clinical features, but it might affect nutritional status.
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Shelley H, Brennan M, Heuschkel R. Hydrogen breath testing in children: What is it and why is it performed? ACTA ACUST UNITED AC 2009. [DOI: 10.12968/gasn.2009.7.5.42906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Robert Heuschkel
- Children′s Services, Addenbrooke′s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
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Eisenmann A, Amann A, Said M, Datta B, Ledochowski M. Implementation and interpretation of hydrogen breath tests. J Breath Res 2008; 2:046002. [DOI: 10.1088/1752-7155/2/4/046002] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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