Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study.
Coeliac disease (CD), a T-cell-mediated gluten sensitive enteropathy, affects ∼ 1% of the UK population and can present with wide ranging clinical features, often being mistaken for Irritable Bowel Syndrome (IBS). Heightened clinical awareness and serological screening identifies those with potentia...
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0107312 |
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| author | Ramesh P Arasaradnam Eric Westenbrink Michael J McFarlane Ruth Harbord Samantha Chambers Nicola O'Connell Catherine Bailey Chuka U Nwokolo Karna D Bardhan Richard Savage James A Covington |
| author_facet | Ramesh P Arasaradnam Eric Westenbrink Michael J McFarlane Ruth Harbord Samantha Chambers Nicola O'Connell Catherine Bailey Chuka U Nwokolo Karna D Bardhan Richard Savage James A Covington |
| author_sort | Ramesh P Arasaradnam |
| collection | DOAJ |
| description | Coeliac disease (CD), a T-cell-mediated gluten sensitive enteropathy, affects ∼ 1% of the UK population and can present with wide ranging clinical features, often being mistaken for Irritable Bowel Syndrome (IBS). Heightened clinical awareness and serological screening identifies those with potential coeliac disease; the diagnosis is confirmed with duodenal biopsies, and symptom improvement with a gluten-free diet. Limitations to diagnosis are false negative serology and reluctance to undergo biopsy. The gut microbiome is altered in several gastrointestinal disorders, causing altered gut fermentation patterns recognisable by volatile organic compounds (VOC) analysis in urine, breath and faeces. We aimed to determine if CD alters the urinary VOC pattern, distinguishing it from IBS. 47 patients were recruited, 27 with established CD, on gluten free diets, and 20 with diarrhoea-predominant IBS (D-IBS). Collected urine was stored frozen in 10 ml aliquots. For assay, the specimens were heated to 40 ± 0.1°C and the headspace analysed by Field Asymmetric Ion Mobility Spectrometry (FAIMS). Machine learning algorithms were used for statistical evaluation. Samples were also analysed using Gas chromatography and mass spectroscopy (GC-MS). Sparse logistic regression showed that FAIMS distinguishes VOCs in CD vs D-IBS with ROC curve AUC of 0.91 (0.83-0.99), sensitivity and specificity of 85% respectively. GCMS showed a unique peak at 4'67 found only in CD, not D-IBS, which correlated with the compound 1,3,5,7 cyclooctatetraene. This study suggests that FAIMS offers a novel, non-invasive approach to identify those with possible CD, and distinguishes from D-IBS. It offers the potential for monitoring compliance with a gluten-free diet at home. The presence of cyclooctatetraene in CD specimens will need further validation. |
| format | Article |
| id | doaj-art-cd9ea5dce4d54d02af2318e100500da1 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-cd9ea5dce4d54d02af2318e100500da12025-08-20T03:46:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01910e10731210.1371/journal.pone.0107312Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study.Ramesh P ArasaradnamEric WestenbrinkMichael J McFarlaneRuth HarbordSamantha ChambersNicola O'ConnellCatherine BaileyChuka U NwokoloKarna D BardhanRichard SavageJames A CovingtonCoeliac disease (CD), a T-cell-mediated gluten sensitive enteropathy, affects ∼ 1% of the UK population and can present with wide ranging clinical features, often being mistaken for Irritable Bowel Syndrome (IBS). Heightened clinical awareness and serological screening identifies those with potential coeliac disease; the diagnosis is confirmed with duodenal biopsies, and symptom improvement with a gluten-free diet. Limitations to diagnosis are false negative serology and reluctance to undergo biopsy. The gut microbiome is altered in several gastrointestinal disorders, causing altered gut fermentation patterns recognisable by volatile organic compounds (VOC) analysis in urine, breath and faeces. We aimed to determine if CD alters the urinary VOC pattern, distinguishing it from IBS. 47 patients were recruited, 27 with established CD, on gluten free diets, and 20 with diarrhoea-predominant IBS (D-IBS). Collected urine was stored frozen in 10 ml aliquots. For assay, the specimens were heated to 40 ± 0.1°C and the headspace analysed by Field Asymmetric Ion Mobility Spectrometry (FAIMS). Machine learning algorithms were used for statistical evaluation. Samples were also analysed using Gas chromatography and mass spectroscopy (GC-MS). Sparse logistic regression showed that FAIMS distinguishes VOCs in CD vs D-IBS with ROC curve AUC of 0.91 (0.83-0.99), sensitivity and specificity of 85% respectively. GCMS showed a unique peak at 4'67 found only in CD, not D-IBS, which correlated with the compound 1,3,5,7 cyclooctatetraene. This study suggests that FAIMS offers a novel, non-invasive approach to identify those with possible CD, and distinguishes from D-IBS. It offers the potential for monitoring compliance with a gluten-free diet at home. The presence of cyclooctatetraene in CD specimens will need further validation.https://doi.org/10.1371/journal.pone.0107312 |
| spellingShingle | Ramesh P Arasaradnam Eric Westenbrink Michael J McFarlane Ruth Harbord Samantha Chambers Nicola O'Connell Catherine Bailey Chuka U Nwokolo Karna D Bardhan Richard Savage James A Covington Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. PLoS ONE |
| title | Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. |
| title_full | Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. |
| title_fullStr | Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. |
| title_full_unstemmed | Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. |
| title_short | Differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis--a pilot study. |
| title_sort | differentiating coeliac disease from irritable bowel syndrome by urinary volatile organic compound analysis a pilot study |
| url | https://doi.org/10.1371/journal.pone.0107312 |
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