Volatile Organic Compounds in Feces Associate With Response to Dietary Intervention in Patients With Irritable Bowel Syndrome
Open accessAbstract
Background & aims Dietary interventions are effective in management of patients with irritable bowel syndrome (IBS), although responses vary. We investigated whether fecal levels of volatile organic compounds (VOCs) associate with response to dietary interventions in patients with IBS.Methods Adults who fulfilled the Rome III criteria for IBS were recruited to a 2x2 factorial randomized controlled trial. Patients were randomly assigned to a group counselled to follow a diet low in fructans, galacto-oligosaccharides, lactose, fructose, and polyols (low-FODMAP diet, n = 46) or a group that received placebo dietary advice (sham diet, n = 47) for 4 weeks. Patients from each group were also given either a multi-strain probiotic or placebo supplement. Response was defined as a reduction of 50 points or more on the validated IBS symptom scoring system. Fecal samples were collected from participants at baseline and end of the 4-week study period; VOCs were analyzed by a gas-chromatography sensor device. VOC profiles were determined using a pipeline involving wavelet transformation followed by feature selection based on random forest. A partial least squares classifier was constructed to classify VOC profiles by response and accuracies were determined using 10-fold cross-validation.Results Data from 93 patients who completed the study (63 female) were used in the final analysis. More patients responded to the low-FODMAP diet (37/46, 80%) than the sham diet (21/47, 45%) (P < .001), but there was no difference in response between patients given the probiotic (31/49, 63%) vs the placebo (27/44, 61%) (P = .850), with no interaction between the diet and supplement interventions. At baseline, VOC profiles contained 15 features that classified response to the low-FODMAP diet with a mean accuracy of 97% (95% CI, 96%-99%) and 10 features that classified response to probiotic with a mean accuracy of 89% (95% CI, 86%-92%). End of treatment models achieved similar predictive powers and accuracies.Conclusion Fecal VOC profiling is a low cost, non-invasive tool that might be used to predict responses of patients with IBS to low-FODMAP diet and probiotics and identify their mechanisms of action. ISRCTN registry no: 02275221.
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Preliminary data suggest that response to a low FODMAP diet may be predicted from baseline faecal bacterial profile and metabolomic activity, while a gluten-free diet may benefit those with serum antigliadin antibodies.
“Preliminary data suggest that response to a low FODMAP diet may be predicted from baseline faecal bacterial profile and metabolomic activity, while a gluten-free diet may benefit those with serum antigliadin antibodies.[213][214][215]”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [214]
Which microbial enzymatic repertoire is required for a dietary intervention to be successful depends on the nutrients present in the study diet.
“Which microbial enzymatic repertoire is required for a dietary intervention to be successful depends on the nutrients present in the study diet (70,494,510).”
From Diet and the Microbiota–Gut–Brain Axis: Sowing the Seeds of Good Mental Health (2021) · cites this paper as [510]
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- Authors
- Rossi, M., Aggio, R., Staudacher, H. M., Lomer, M. C., Lindsay, J. O., Irving, P., Probert, C., & Whelan, K.
- Affiliations
- King's College London (GB)
- University of Liverpool (GB)
- Queen Mary University of London (GB)
- Corresponding author
- Whelan, Kevin
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 16
- Issue
- 3
- Pages
- 385-391.e1
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2762056035
- Cited by
- 122
- References
- 32
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 14 · 2023: 13 · 2022: 21 · 2021: 13 · 2020: 17 · 2019: 17 · 2018: 10
- FWCI
- 12.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by-nc-nd)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Physical Sciences › Engineering › Biomedical Engineering › Advanced Chemical Sensor Technologies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, volatile organic compounds, low FODMAP diet, probiotics, treatment response biomarkers, wavelet transform, feature selection, non-invasive biomarkers, nutrition counseling, lactose
- MeSH terms
- Adult, Diet Therapy, Feces, Female, Humans, Male, Middle Aged, Placebos, Treatment Outcome, Probiotics, Irritable Bowel Syndrome, Volatile Organic Compounds
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