Headspace screening of fluid obtained from the gut during colonoscopy and breath analysis by proton transfer reaction-mass spectrometry: A novel approach in the diagnosis of gastro-intestinal diseases

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Abstract

Background:

The diagnosis of many gastro-intestinal diseases is difficult and can often be confirmed only by using invasive diagnostic means. In contrast, the headspace screening of fluid obtained from the gut during colonoscopy and the analysis of exhaled air may be a novel approach for the diagnosis of these diseases.

Materials and methods:

The screening was performed by using proton transfer reaction-mass spectrometry (PTR-MS) which allows rapid and sensitive measurement. Fluid samples obtained from the gut during colonoscopy were collected from 76 and breath samples from 70 subjects. Mass spectra of healthy controls were created. Afterwards these spectra were compared with those of patients suffering from inflammatory bowel diseases (IBD; Crohn's disease and ulcerative colitis; n = 10) and irritable bowel syndrome (IBS; n = 7).

Results:

Significant differences in the mass spectra could be observed both in the headspace of the fluid and in the exhaled air comparing patients with healthy controls.

Conclusions:

This study is the first describing headspace screening of fluid obtained from the gut during colonoscopy, possibly presenting a novel diagnostic tool in the differential diagnosis of gastro-intestinal diseases.

Introduction

Over the past decade, the analysis of volatile organic compounds (VOC) has witnessed an enormous boost. Several studies dealing with this topic demonstrated that various diseases, e.g. lung cancer [1], [2], breast cancer [3], schizophrenia [4] and recent smoking behaviour [5], [6] are associated with a specific VOC-profile either in human exhaled air, or in the headspace of body fluids [7]. These patterns differ explicitly from that of healthy subjects and are specific for the mentioned diseases.

Whereas breath analysis has been performed in numerous studies, no publication describes the mass spectrum in the headspace of fluid obtained from the gut during colonoscopy. This fluid is obtained easily and without additional risks or expenses in the course of the procedure. Normally being discarded at the end, the analysis of these spectra could possibly represent a novel methodical approach in diagnosing gastro-intestinal diseases and/or finally contribute to a better understanding of their pathophysiology.

The aim of our current study is to describe the mass spectrum in the headspace of the “colonoscopy-fluid”, and in the exhaled air of healthy controls, and to compare this pattern with that of patients suffering from inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). It might become possible to attribute a specific mass spectrum to both inflammatory bowel diseases and irritable bowel syndrome and to allow a rapid diagnosis by measuring real-time and analyzing the mass spectrum within minutes. In contrast, conventional methods, e.g. the histopathological evaluation of a biopsy, are far more time consuming.

Section snippets

Patients

All patients who were enrolled in the study underwent elective colonoscopy. The preparation for the procedure included the application of a laxative the day before and all patients had to fast over night. Before the colonoscopy test subjects were asked to exhale into a sample bag (Adtech, Gloucestershire, UK) as previously described [8]. In brief, patients had to discard the first part of expired air and exhaled only the deep portion into the sample bag. Then colonoscopy-fluid was obtained from

Results

Initially proton transfer reaction-mass spectra in the headspace of the fluid and in the exhaled air of healthy controls were created. These spectra were compared with those of patients suffering from IBD and IBS. The concentration of ions at 209 different m/z values was evaluated. For the most part, the corresponding substances are thought to be hydrocarbons, in particular alkanes, alkenes, alcohols, ketones, and organic acids. The mean concentration is given in parts per billion volume (ppbv).

Discussion

This study is the first describing the headspace proton transfer reaction-mass spectrum of fluid obtained from the gut during colonoscopy. The following could be observed: only ions at 12 (of the 209 evaluated) m/z values were detected in all subjects. Ions at each of the 209 evaluated m/z values (with the exception of m/z 179) could be found in the headspace of at least one sample, even though partly in very low concentrations. The results also show that the concentration of ions at certain m/z

Conclusion and perspectives

In the future, it might become possible to collate a specific mass spectrum to the above-mentioned diseases. Nevertheless, much effort has to be made and the reliability of this approach has to be proven. Different methods like GC–MS (gas chromatography–mass spectroscopy) will help identify the exact substances and contribute to the basic understanding of gastro-intestinal diseases.

Acknowledgements

This work was supported by the Austrian Federal Science Fund (FWF) with grant P-14149 MED to Josef Rieder and grant P-17447 to Herbert Tilg. We acknowledge the invaluable help of Prof. Dr. Manfred P. Dierich (Institute of Hygiene, University of Innsbruck, Austria) and of Dr. Alfons Jordan (Institute of Ion Physics, University of Innsbruck, Austria). Moreover, we would like to thank Dr. Rainer Mayr and Josef Schoenegger for the statistical analysis of the data.

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