Abstract
Increasing interest is noticed in the potential of volatile organic compound (VOC) analysis as non-invasive diagnostic biomarker in clinical medical practice. The spectrum of VOCs, originating from (patho)physiological metabolic processes in the human body and detectable in bodily excrements, such as exhaled breath, urine and feces, harbors a magnificent source of information. Thus far, the majority of studies have focused on VOC analysis in exhaled breath, aiming at identification of disease-specific VOC profiles. Recently, an increasing number of studies have evaluated the usability of VOC present in the headspace of feces in the diagnostic work-up of a wide range of gastrointestinal diseases. Promising results have been demonstrated particularly in those diseases in which microbiota alterations are considered to play a significant etiological role, such as colorectal carcinoma, inflammatory bowel disease, irritable bowel syndrome, celiac disease and infectious bowel diseases. In addition, fecal VOC analysis seems to have potential as a diagnostic biomarker for extra-intestinal diseases, including bronchopulmonary dysplasia and sepsis. Different methods for VOC analysis have been used in medical studies, such as gas-chromatography mass spectrometry, selected-ion flow tube-mass spectrometry, ion-mobility spectrometry, and electronic nose devices. In this review, the available literature on the potential of fecal VOCs as diagnostic biomarker, including an overview of relevant VOC detection techniques, is discussed. In addition, future hurdles, which need to be taken prior to implementation of VOC analysis in daily clinical practice, are outlined.
Highlights
In a significant number of diseases, alternative disease-detection technologies are warranted, for example in gastrointestinal diseases where colonoscopies, tissue biopsies and microbial culture tests remain a mandatory diagnostic tool in the majority of cases
Inflammatory bowel disease (IBD) is a chronic relapsing condition of the gastrointestinal tract which usually develops in the teens or young adulthood, and comprises the phenotypes ulcerative colitis (UC) and Crohn’s disease (CD)
This study demonstrated that classification based on volatile organic compound (VOC) profiles was possible with good sensitivity and specificity (Table 3)
Summary
In a significant number of diseases, alternative disease-detection technologies are warranted, for example in gastrointestinal diseases where colonoscopies, tissue biopsies and microbial culture tests remain a mandatory diagnostic tool in the majority of cases. These techniques are commonly invasive, expansive, time-consuming, and carry a high burden on patients. VOCs are carbon-based chemicals which under normal indoor atmospheric conditions of temperature and pressure evaporate to the ambient air They are emitted from the body as a product of both physiological and pathophysiological metabolic processes, and can be detected in sweat, urine, exhaled breath, feces, blood and vaginal secretions [7]. Hurdles that need to be overcome prior to clinical implementation of VOC analysis as a non-invasive diagnostic mean are outlined
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