Breath Analysis in Inflammatory Bowel Diseases
Breath Analysis in Inflammatory Bowel Diseases
The breath metabolome provides a novel and exciting opportunity to discover new biomarkers of IBD by providing non-invasive fingerprints for diagnosis and disease stratification. It remains an essentially untapped source for biomarker discovery considering that more than 3000 VOC markers in the breath condensate are still to be identified and could be linked to disease pathophysiology. Currently, commercially available and FDA-approved clinical breath tests in the United States have been limited to assessing ventilation and anaesthesia, H. pylori infection, asthma and airway inflammation, heart transplant or breath alcohol detection. The experience with breath analysis in other diseases is encouraging. While this represents a highly promising approach, given the paucity of clinical studies breath tests are not yet ready for routine clinical use in IBD. Future investigations need to include the latest breath analysis technology, allowing the detection of a wide variety of compounds in real time, and carefully designed prospective long-term follow-up cohorts. For diagnosis this should include patients with symptoms consistent with IBD, but prior to diagnosis or differentiation. For disease stratification this should incorporate very thoroughly characterised IBD patients at the time of sample procurement. The future technical and pathophysiological challenges lie in identification of all unknown breath compounds, the mapping and maintenance of breath print repositories and the integration with existing genomic, epigenomic, transcriptomic and proteomic databases. It is evident that the potential to harness more information from breath VOCs and translate it into clinically applicable tests for IBD remains immense.
Conclusions
The breath metabolome provides a novel and exciting opportunity to discover new biomarkers of IBD by providing non-invasive fingerprints for diagnosis and disease stratification. It remains an essentially untapped source for biomarker discovery considering that more than 3000 VOC markers in the breath condensate are still to be identified and could be linked to disease pathophysiology. Currently, commercially available and FDA-approved clinical breath tests in the United States have been limited to assessing ventilation and anaesthesia, H. pylori infection, asthma and airway inflammation, heart transplant or breath alcohol detection. The experience with breath analysis in other diseases is encouraging. While this represents a highly promising approach, given the paucity of clinical studies breath tests are not yet ready for routine clinical use in IBD. Future investigations need to include the latest breath analysis technology, allowing the detection of a wide variety of compounds in real time, and carefully designed prospective long-term follow-up cohorts. For diagnosis this should include patients with symptoms consistent with IBD, but prior to diagnosis or differentiation. For disease stratification this should incorporate very thoroughly characterised IBD patients at the time of sample procurement. The future technical and pathophysiological challenges lie in identification of all unknown breath compounds, the mapping and maintenance of breath print repositories and the integration with existing genomic, epigenomic, transcriptomic and proteomic databases. It is evident that the potential to harness more information from breath VOCs and translate it into clinically applicable tests for IBD remains immense.
