The potential of volatile organic compounds for the detection of active disease in patients with ulcerative colitis

Aliment Pharmacol Ther. 2017 May;45(9):1244-1254. doi: 10.1111/apt.14004. Epub 2017 Feb 26.


Background: To optimise treatment of ulcerative colitis (UC), patients need repeated assessment of mucosal inflammation. Current non-invasive biomarkers and clinical activity indices do not accurately reflect disease activity in all patients and cannot discriminate UC from non-UC colitis. Volatile organic compounds (VOCs) in exhaled air could be predictive of active disease or remission in Crohn's disease.

Aim: To investigate whether VOCs are able to differentiate between active UC, UC in remission and non-UC colitis.

Methods: UC patients participated in a 1-year study. Clinical activity index, blood, faecal and breath samples were collected at each out-patient visit. Patients with clear defined active faecal calprotectin >250 μg/g and inactive disease (Simple Clinical Colitis Activity Index <3, C-reactive protein <5 mg/L and faecal calprotectin <100 μg/g) were included for cross-sectional analysis. Non-UC colitis was confirmed by stool culture or radiological evaluation. Breath samples were analysed by gas chromatography time-of-flight mass spectrometry and kernel-based method to identify discriminating VOCs.

Results: In total, 72 UC (132 breath samples; 62 active; 70 remission) and 22 non-UC-colitis patients (22 samples) were included. Eleven VOCs predicted active vs. inactive UC in an independent internal validation set with 92% sensitivity and 77% specificity (AUC 0.94). Non-UC colitis patients could be clearly separated from active and inactive UC patients with principal component analysis.

Conclusions: Volatile organic compounds can accurately distinguish active disease from remission in UC and profiles in UC are clearly different from profiles in non-UC colitis patients. VOCs have demonstrated potential as new non-invasive biomarker to monitor inflammation in UC.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / analysis
  • Breath Tests
  • C-Reactive Protein / analysis
  • Colitis / blood
  • Colitis / diagnosis*
  • Cross-Sectional Studies
  • Feces / chemistry
  • Female
  • Gas Chromatography-Mass Spectrometry
  • Humans
  • Leukocyte L1 Antigen Complex / analysis
  • Male
  • Middle Aged
  • Outpatients
  • Sensitivity and Specificity
  • Volatile Organic Compounds / analysis*


  • Biomarkers
  • Leukocyte L1 Antigen Complex
  • Volatile Organic Compounds
  • C-Reactive Protein