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Fructans Exacerbate Childhood Irritable Bowel Syndrome Symptoms
Table 1: Comparison of symptoms, gas production, and stooling habits during randomized, double-blind, cross-over, 72 hour fructan vs. maltodextrin dietary interventions in 23 children with IBS
AGA Abstracts
Table 1: Response to stress scores for controls compared with children with FGIDs, FC, and AP-FGIDs after controlling for age and sex
758 DETECTION OF BARRETT'S ESOPHAGUS VIA ELECTRONIC-NOSE DEVICE ANALYSIS OF EXHALED VOLATILE ORGANIC COMPOUNDS IN BREATH SAMPLES Liam Zakko, Daniel K. Chan, Kavel Visrodia, James Allen, Lori S. Lutzke, Magdalen A. Clemens, Cadman L. Leggett, Kenneth K. Wang Background Due to late discovery, esophageal adenocarcinoma (EAC) continues to have a poor prognosis. While Barrett's esophagus (BE) is a known precursor, EAC is usually diagnosed outside of BE surveillance programs, suggesting a lack of adequate screening. Current screening programs for BE are costly and invasive. In an effort to develop a more acceptable, less expensive screening method, we are piloting a non-invasive, highly portable electronic nose device (e-nose) to detect BE from breath samples. Methods A group of patients (Group BE) in a BE surveillance program were asked to provide a 5-minute breath test using an e-nose (Aeonose, eNose Company, Zutphen, NL) prior to routinely scheduled EGD. Patients with active BE (defined as ≥ 1 cm of columnar mucosa from the gastroesophageal junction with histopathologic confirmation of intestinal metaplasia) were included. Patients with a history of BE but no active BE were excluded. A second group of patients with no history of BE (Group No BE) were asked to provide a 5-minute breath test using the same e-nose. Disposables per breath test were only a cardboard mouthpiece and 2 filters, limiting the cost. The e-nose circulates the continuous breath sample over a metal-oxide sensor array for 5-minutes. Three separate sensors interact with volatile organic compounds (VOC) in the breath sample to create a digital signature through reduction-oxidation reactions at the metal-oxide sensor's surface. These VOC-sensor interactions are maximized through the use of a 32-point thermal cycle. Digital signatures are then introduced into an artificial neural network to perform pattern recognition analysis between breath samples from fasting and non-fasting subjects. Optimal models were cross-validated using a leave-one-out approach to achieve predicated performance characteristics. Results Breath samples were obtained from a total of 104 individuals; 69 in Group BE and 35 in Group no BE. Optimal multivariate modeling based on our VOC signatures demonstrated a predictive model for active BE with performance characteristics of 94% sensitivity, 60% specificity, 83% accuracy and AUC=0.77 (Figure 1). The positive predictive value was 0.82 and negative predictive value was 0.84. The Matthews Correlation Coefficient was 0.60. Recruitment rates were 95.6% for breath testing. Conclusion Electronic nose technology is able to distinguish patients with active BE from those without BE by VOC analysis of patient breath samples. Though its specificity and accuracy are moderate, its high sensitivity is desirable in a screening test. Given its low cost and high patient acceptability, e-nose analysis of VOCs from patient breath samples is a potential method to significantly expand primary screening of BE.
*denotes p<0.05, **p<0.01, ***p<0.001
743b FRUCTANS EXACERBATE CHILDHOOD IRRITABLE BOWEL SYNDROME SYMPTOMS Bruno P. Chumpitazi, Ann R. McMeans, Adetola Vaughan, Shannon B. Orlando, Amna Ali, Ali Elsaadi, Robert J. Shulman Background: Children with irritable bowel syndrome (IBS) may have dietary triggers which exacerbate their gastrointestinal (GI) symptoms. Dietary fructans (such as inulin) may worsen GI symptoms in adults with IBS via increased gas production. Whether fructans similarly worsen GI symptoms in children with IBS is unknown. Objectives: To determine whether fructans serve as a dietary trigger and to evaluate the role of fructan-induced gas production on symptoms in children with IBS. Methods: Children 7-18 yrs. with pediatric Rome III IBS completed a double-blind, randomized, placebo controlled crossover trial. Subjects were provided low FODMAP foods with blinded drinks for 72 hours. The drinks provided either inulin-type fructans (0.5 g/kg/day up to 17 grams) or maltodextrin (placebo, same dosage). Subjects consumed the initial food/drink assignment for 72 hours. Following a minimum 10-day washout period on a regular diet, subjects were crossed over to the opposite food/ drink assignment for 72 hours. During each dietary intervention subjects completed a symptom diary capturing abdominal pain frequency (primary outcome), pain severity, bloating, gas, nausea, fatigue, bowel movement frequency, and stool type (using the modified Bristol Stool Form Scale for Children). During the final 8 hours of each dietary intervention, subjects provided hourly breath samples to measure hydrogen and methane (area under the curve) production. Fructan sensitivity was defined as a ≥ 30% increase in abdominal pain frequency during the fructan vs. maltodextrin intervention. Results: Twenty three children with IBS completed the study of whom 15 (65.2%) had IBS-C, 4 (17.4%) IBS-M, 2 (8.7%) IBS-U, and 2 (8.7%) IBS-D. Mean age was 9.2 ± 2.2 (SD) years with 19 (82.6%) females; 20 (87%) were White, 2 (9.1%) Multi-racial, 1 (4.3%) Black and 12 (52.2%) were Hispanic. Increased pain frequency, bloating, and gas occurred during the fructan (vs. maltodextrin) intervention (Table 1). Hydrogen but not methane excretion was greater during the fructan intervention (Table 1). Bowel movement frequency and mean stool type did not differ during the interventions (Table 1). Gas production during the fructan intervention did not correlate with the severity of any symptom. Twelve (52.2%) subjects were fructan sensitive. Fructan sensitive subjects did not differ from fructan insensitive subjects with respect to hydrogen production (617 ± 77 vs. 618 ± 357 ppm*hr., respectively) or methane production (155 ± 117 vs. 142 ± 80 ppm*hr., respectively) during the fructan challenge. Conclusions: In children with IBS fructans worsen abdominal pain frequency, bloating, and gas. A subset of children with IBS is fructan sensitive. Gas production alone during a fructan challenge did not distinguish those who are fructan sensitive vs insensitive.
Figure 1: Barrett's Breath Detection Predictive Model Receiver Operating Curve
AGA Abstracts
S-164
AGA Abstracts
Table 1: Response to stress scores for controls compared with children with FGIDs, FC, and AP-FGIDs after controlling for age and sex
758 DETECTION OF BARRETT'S ESOPHAGUS VIA ELECTRONIC-NOSE DEVICE ANALYSIS OF EXHALED VOLATILE ORGANIC COMPOUNDS IN BREATH SAMPLES Liam Zakko, Daniel K. Chan, Kavel Visrodia, James Allen, Lori S. Lutzke, Magdalen A. Clemens, Cadman L. Leggett, Kenneth K. Wang Background Due to late discovery, esophageal adenocarcinoma (EAC) continues to have a poor prognosis. While Barrett's esophagus (BE) is a known precursor, EAC is usually diagnosed outside of BE surveillance programs, suggesting a lack of adequate screening. Current screening programs for BE are costly and invasive. In an effort to develop a more acceptable, less expensive screening method, we are piloting a non-invasive, highly portable electronic nose device (e-nose) to detect BE from breath samples. Methods A group of patients (Group BE) in a BE surveillance program were asked to provide a 5-minute breath test using an e-nose (Aeonose, eNose Company, Zutphen, NL) prior to routinely scheduled EGD. Patients with active BE (defined as ≥ 1 cm of columnar mucosa from the gastroesophageal junction with histopathologic confirmation of intestinal metaplasia) were included. Patients with a history of BE but no active BE were excluded. A second group of patients with no history of BE (Group No BE) were asked to provide a 5-minute breath test using the same e-nose. Disposables per breath test were only a cardboard mouthpiece and 2 filters, limiting the cost. The e-nose circulates the continuous breath sample over a metal-oxide sensor array for 5-minutes. Three separate sensors interact with volatile organic compounds (VOC) in the breath sample to create a digital signature through reduction-oxidation reactions at the metal-oxide sensor's surface. These VOC-sensor interactions are maximized through the use of a 32-point thermal cycle. Digital signatures are then introduced into an artificial neural network to perform pattern recognition analysis between breath samples from fasting and non-fasting subjects. Optimal models were cross-validated using a leave-one-out approach to achieve predicated performance characteristics. Results Breath samples were obtained from a total of 104 individuals; 69 in Group BE and 35 in Group no BE. Optimal multivariate modeling based on our VOC signatures demonstrated a predictive model for active BE with performance characteristics of 94% sensitivity, 60% specificity, 83% accuracy and AUC=0.77 (Figure 1). The positive predictive value was 0.82 and negative predictive value was 0.84. The Matthews Correlation Coefficient was 0.60. Recruitment rates were 95.6% for breath testing. Conclusion Electronic nose technology is able to distinguish patients with active BE from those without BE by VOC analysis of patient breath samples. Though its specificity and accuracy are moderate, its high sensitivity is desirable in a screening test. Given its low cost and high patient acceptability, e-nose analysis of VOCs from patient breath samples is a potential method to significantly expand primary screening of BE.
*denotes p<0.05, **p<0.01, ***p<0.001
743b FRUCTANS EXACERBATE CHILDHOOD IRRITABLE BOWEL SYNDROME SYMPTOMS Bruno P. Chumpitazi, Ann R. McMeans, Adetola Vaughan, Shannon B. Orlando, Amna Ali, Ali Elsaadi, Robert J. Shulman Background: Children with irritable bowel syndrome (IBS) may have dietary triggers which exacerbate their gastrointestinal (GI) symptoms. Dietary fructans (such as inulin) may worsen GI symptoms in adults with IBS via increased gas production. Whether fructans similarly worsen GI symptoms in children with IBS is unknown. Objectives: To determine whether fructans serve as a dietary trigger and to evaluate the role of fructan-induced gas production on symptoms in children with IBS. Methods: Children 7-18 yrs. with pediatric Rome III IBS completed a double-blind, randomized, placebo controlled crossover trial. Subjects were provided low FODMAP foods with blinded drinks for 72 hours. The drinks provided either inulin-type fructans (0.5 g/kg/day up to 17 grams) or maltodextrin (placebo, same dosage). Subjects consumed the initial food/drink assignment for 72 hours. Following a minimum 10-day washout period on a regular diet, subjects were crossed over to the opposite food/ drink assignment for 72 hours. During each dietary intervention subjects completed a symptom diary capturing abdominal pain frequency (primary outcome), pain severity, bloating, gas, nausea, fatigue, bowel movement frequency, and stool type (using the modified Bristol Stool Form Scale for Children). During the final 8 hours of each dietary intervention, subjects provided hourly breath samples to measure hydrogen and methane (area under the curve) production. Fructan sensitivity was defined as a ≥ 30% increase in abdominal pain frequency during the fructan vs. maltodextrin intervention. Results: Twenty three children with IBS completed the study of whom 15 (65.2%) had IBS-C, 4 (17.4%) IBS-M, 2 (8.7%) IBS-U, and 2 (8.7%) IBS-D. Mean age was 9.2 ± 2.2 (SD) years with 19 (82.6%) females; 20 (87%) were White, 2 (9.1%) Multi-racial, 1 (4.3%) Black and 12 (52.2%) were Hispanic. Increased pain frequency, bloating, and gas occurred during the fructan (vs. maltodextrin) intervention (Table 1). Hydrogen but not methane excretion was greater during the fructan intervention (Table 1). Bowel movement frequency and mean stool type did not differ during the interventions (Table 1). Gas production during the fructan intervention did not correlate with the severity of any symptom. Twelve (52.2%) subjects were fructan sensitive. Fructan sensitive subjects did not differ from fructan insensitive subjects with respect to hydrogen production (617 ± 77 vs. 618 ± 357 ppm*hr., respectively) or methane production (155 ± 117 vs. 142 ± 80 ppm*hr., respectively) during the fructan challenge. Conclusions: In children with IBS fructans worsen abdominal pain frequency, bloating, and gas. A subset of children with IBS is fructan sensitive. Gas production alone during a fructan challenge did not distinguish those who are fructan sensitive vs insensitive.
Figure 1: Barrett's Breath Detection Predictive Model Receiver Operating Curve
AGA Abstracts
S-164