MDPI Magazine MDPI Magazine13 September 2013 Recent Advances

Good News for Bile Acid Diarrhea

Bile acid diarrhea is a common cause of chronic diarrhea and can be highly debilitating, causing a significant reduction in the quality of life. It is unfortunately under-recognized and under-diagnosed by clinicians as the cause for this common affliction. This is mostly due to current definitive testing requiring expensive and advanced nuclear medicine technology that is not commonly available or not used at all in some countries (such as the US).

It is important to distinguish bile acid diarrhea from the less common, but more widely recognized cause of chronic diarrhea, ulcerative colitis, because the effective treatment strategies and medications are very different. In the Sensors Special Issue Sensing of Scent, Fragrance, Smell, and Odor Emissions from Biota Sources, Covington et al., demonstrate for the first time the possibility to use a simpler and more cost effective method for distinguishing bile acid diarrhea cases from healthy controls and ulcerative colitis patients based on the detection of volatile organic compounds (VOCs) released from patient urine samples.

VOCs and other gases are produced from colonic fermentation and are released through body fluids, thus providing biomarkers in urine, faeces, breath and other biological waste products to assess and monitor gastrointestinal diseases.

Application of sensors for bile acid diarrhea

In ‘Application of a Novel Tool for Diagnosing Bile Acid Diarrhoea, the ‘Fox’, an ‘electronic nose’ instrument that aims to mimic biological olfactory capabilities, was used to detect and also recognize odours that emanate from a urine sample. In short, this instrument ‘sniffed’ the enclosed gas space directly above the urine sample, also known as the ‘headspace’, for VOCs. Also tested was FAIMS (Field Asymmetric Ion Mobility Spectrometry), a fairly recent technology that separates chemical compounds based on their ion mobility in high electric fields, but importantly achieves this separation at room temperature and at atmospheric pressure.

Both of these instruments were able to distinguish chemical signatures of bile acid diarrhea from control samples and other ulcerative colitis at a high rate of greater than 80%. Further studies with larger patient groups are planned to confirm these results, understand the best methods for collecting and testing these samples and to choose the most appropriate technology that can be deployed within a medical setting for the identification of this debilitating disease.

About Dr. Covington

James Covington image for article about bile acid diarrhea
Dr. James Covington is a Professor at the School of Engineering, Warwick University. For over a decade Dr. Covington has been developing novel chemical sensors, sensing materials, as well as micro-systems. These components are common in many gas detectors and so-called electronic noses and attempt to mimic the human olfactory system. These systems can identify the odors of environmental pollutants and also explosives. Dr. Covington has worked closely with medics at University Hospital Coventry and Warwickshire and Rotherham Hospital to apply these gas analyzers and electronic noses to the medical domain in an attempt to find new non-invasive and patient friendly methods to help diagnose and monitor patients with gastroenterological diseases.

Further Reading

For a more complete list of related open access articles, please see here.