Portable 'electronic nose' can accurately screen Barrett's oesophagus

A new Portable 'electronic nose' can accurately screen Barrett's oesophagus.

A portable 'electronic nose' can accurately pick up the precursor condition to food pipe (oesophageal) cancer, known as Barrett's oesophagus, indicates a proof of principle study, published online in the journal Gut. Researchers found that the accuracy of the electronic nose was high, especially among patients taking a high-dose proton pump inhibitor, an acid reduction medicine.

This inexpensive and non-invasive technique may be a promising test for diagnosing oesophageal cancer in primary care, say the researchers. 

The number of new cases of this cancer has risen sixfold over the past few decades, with most cases being diagnosed when the disease is already advanced and difficult to treat. 

Barrett's oesophagus, a condition in which healthy cells lining the food pipe are replaced by abnormal cells, is a known precursor to the disease. 

It can be diagnosed using a long flexible tube with a camera on the end (endoscope). But the procedure is expensive and unpleasant for patients, making it unsuitable for population screening. 

So scientists have been exploring other less invasive and cheaper options, including analysis of volatile organic compounds, or VOCs for short. 

VOCs are gaseous compounds produced by metabolic processes in the body, including inflammation and abnormal cellular activity, which can be detected in a person's breath. 

The researchers wanted to see how effective and accurate a portable 'electronic nose' device would be for picking up Barrett's oesophagus. 

Some 402 adults scheduled for endoscopy breathed into a highly sensitive electronic nose, designed to detect subtle differences in VOC patterns, for 5 minutes. 

Of this group, 129 patients had Barrett's oesophagus; 141 had acid reflux disease, including 50 who had an inflamed oesophagus as a result; and 132 had a normal oesophagus or hiatus hernia that accounted for their symptoms. 

Analysis of the VOC profiles detected by the electronic nose showed that these differed significantly among patients with Barrett's oesophagus, acid reflux, and those with a normal oesophagus/hernia.

The sensitivity of the device was 91%--in other words, its ability to pick up Barrett's oesophagus--and its specificity was 74%--in other words, its ability to detect those without the condition. 

When the analysis was further restricted to patients who had been taking drugs (proton pump inhibitors) to curb stomach acid production for at least a month or those with a hiatus hernia, both of which are likely to muddy the diagnostic waters, its accuracy was still good. 

"The findings of our study provide evidence that patients with [Barrett's oesophagus] have VOC breath prints different from those without," they write. 

While it's still not clear exactly how breath VOCs indicate cancerous cell changes, the sensitivity and specificity of VOC breath testing for Barrett's oesophagus is comparable to that of breast cancer and bowel cancer screening, they explain. 

Chemical analytical techniques for VOC analysis have also been used, and are very effective, but they are also expensive. What's more, they are time-consuming and require highly skilled staff to operate them and analyse the results, point out the researchers. 

Further research will be required to validate these findings in a much larger study, they emphasise. But they conclude: "Given the high tolerability, high acceptability and low costs, breath testing may be a promising approach to be used for non-invasive screening for [Barrett's oesophagus] in a primary care setting."

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Second person to be HIV-free spells hope for the global Aids fight

For the second time in history, a person carrying the Human Immunodeficiency Virus (HIV) has been cured.

Almost 12 years after the first person became HIV-free, doctors have managed to replicate that success, something medical professionals all over the world tried long and hard to do.

An article details how the second patient is in “long-term remission”, similar to the first one.

How does this ‘cure’ work?

The  researchers prefer publicly calling the treatment a “long-term remission” because the idea of this being a fool-proof cure for HIV is inaccurate.

It is difficult to officially designate a treatment as a “cure” if there are only two known instances of it, they add.

Nonetheless, both treatments have a commonality: bone-marrow transplants. The transplants initially intended to treat cancer in the two patients.

A California resident, initially known only as the “Berlin patient”, became the first to be HIV-free. He had two stem cell transplants that cleared his body of HIV, according to reports.

It is reported that both patients’ immune systems were first “wiped out” via chemotherapy and then replaced with stem cell transplants and non-malignant donor cells. 

The bone marrow transplants infused their body with much-needed immunity, which then resisted the spread of HIV.

Such a transplant is not a realistic mass technique yet because it is very risky, has serious complications, and is difficult to replicate.

The report  says that despite efforts to duplicate Brown’s treatment, patients tested positive around nine months after they stopped taking anti-HIV drugs. 

However, the second person, who prefers to remain anonymous and is being called the “London patient”, has been off anti-HIV drugs for over 16 months now and has tested negative for the virus.

Hope for future treatments?

Currently, doctors prescribe anti-HIV drugs, such as non-nucleoside reverse transcriptase inhibitors or entry inhibitors, that not only prevent HIV cells from duplication but also prevent them from entering white blood cells.

However, Brown’s doctor said, “By repeating the procedure in another patient, there is more evidence that the ‘Berlin patient’ is not an exception.”

The London patient’s treatment was also much less harsh than Brown’s, giving medical professionals and patients renewed hope.

The London patient told the reporters, “I feel a sense of responsibility to help doctors understand how it happened so they can develop the science.”

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