Differentiation Between Pediatric Irritable Bowel Syndrome and Inflammatory Bowel Disease Based on Fecal Scent: Proof of Principle Study

Bosch S1, van Gaal N1, Zuurbier RP2, Covington JA3, Wicaksono AN3, Biezeveld MH4, Benninga MA5, Mulder CJ1, de Boer NKH1, de Meij TGJ6. Inflamm Bowel Dis. 2018 May 18. doi: 10.1093/ibd/izy151. [Epub ahead of print]

Author information

1 Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands.

2 Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, the Netherlands.

3 School of Engineering, University of Warwick, Coventry, United Kingdom.

4 Department of Pediatrics, OLVG, Amsterdam, the Netherlands.

5 Pediatric Gastroenterology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.

6 Department of Pediatric Gastroenterology, VU University Medical Centre, Amsterdam, the Netherlands.


BACKGROUND: The diagnostic work-up of pediatric irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) commonly includes invasive tests for discrimination from inflammatory bowel disease (IBD). As this carries a high burden on patients, an ongoing need exists for development of noninvasive diagnostic biomarkers for IBS and FAP-NOS. Several studies have shown microbiota alterations in IBS/FAP, which are considered to be reflected by fecal volatile organic compounds (VOCs). The object of the study was to evaluate whether pediatric IBS/FAP-NOS could be discriminated from IBD and healthy controls by fecal VOC analysis.

METHODS: IBS/FAP-NOS was diagnosed according to the ROME IV criteria, and de novo IBD patients and healthy controls (HCs) aged 4 to 17 years were matched on age and sex. Fecal VOCs were analyzed by means of field asymmetric ion mobility spectrometry.

RESULTS: Fecal VOCs of 15 IBS/FAP-NOS, 30 IBD (15 ulcerative colitis, 15 Crohn's disease) patients and 30 HCs were analyzed and compared. Differentiation between IBS/FAP-NOS and IBD was feasible with high accuracy (area under the curve [AUC], 0.94; 95% confidence interval [CI], 0.88-1; P < 0.00001). IBS/FAP-NOS profiles could not be differentiated from HCs (AUC, 0.59; 95% CI, 0.41-0.77; P = 0.167), whereas IBD profiles could with high accuracy (AUC, 0.96; 95% CI, 0.93-1; P < 0.00001).

CONCLUSION: Pediatric IBS/FAP-NOS could be differentiated from IBD by fecal VOC analysis with high accuracy, but not from healthy controls. The latter finding limits the potential of fecal VOCs to serve as a diagnostic biomarker for IBS/FAP-NOS. However, VOC could possibly serve as additional noninvasive biomarker to differentiate IBS/FAP-NOS from IBD.

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